Methods for treatment of H. pylori infections

ABSTRACT

The present invention relates to inhibitors of the interaction between H. pylori IIopQ and a member of the carcinoembryonic antigen-related cell adhesion molecule (CEACAM) family as well as to immunogenic compositions based on H. pylori HopQ. The present invention further relates to the use of the inhibitors and immunogenic compositions for preventing or treating a disease or disorder caused by or associated with H. pylori.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a U.S. National Stage Application under 35 U.S.C. §371 of International Application No. PCT/EP2017/068297, filed Jul. 20,2017, which claims the benefit of and priority to European PatentApplication No. 16180430.7, filed Jul. 20, 2016. Each of theseapplications is hereby incorporated by reference in its entirety.

REFERENCE TO A SEQUENCE LISTING

A sequence listing containing SEQ ID NOs: 1-33 is provided herewith in acomputer-readable nucleotide/amino acid .txt file and is specificallyincorporated by reference. The name of the ASCII text file is 120-18 USseqlisting 14apr2020, date of creation is Apr. 14, 2020, and the size is50k bytes.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to inhibitors of the interaction betweenH. pylori HopQ and a member of the carcinoembryonic antigen-related celladhesion molecule (CEACAM) family as well as to immunogenic compositionsbased on H. pylori HopQ. The present invention further relates to theuse of the inhibitors and immunogenic compositions for preventing ortreating a disease or disorder caused by or associated with H. pylori.

BACKGROUND OF THE INVENTION

Helicobacter pylori (H. pylori) is a microaerophilic gram-negativebacterium, able to persist lifelong in the human stomach. H. pyloriinfection is the most common bacterial infectious disease in humans:about half of the worldwide population is infected with H. pylori,depending on the socioeconomic status of the region (Perez-Perez et al.,2004). The infection is associated with numerous gastric diseases suchas chronic atrophic gastritis, peptic ulcers, stomach or gastric cancerand the mucosa associated lymphoid tissue (MALT) lymphoma (Nomura etal., 1994; Forman, 1996; Parsonnet et al., 1991; Blaser et al., 1995).H. pylori is the main cause of gastric cancer—the third most common typeof cancer with 983.000 cases worldwide in 2011 (Jemal et al., 2011).

Gastric cancer is associated with considerable socio-economic costs.Treating a single patient with gastric cancer currently costs about EUR50.000. Prevention of gastric cancer includes early treatment ofinfection caused by H. pylori. According to estimates, at least onethird of individuals with an infection caused by H. pylori requiretreatment. At present, it is difficult to predict which patients willdevelop the subsequent diseases associated with an H. pylori infection.Based on the results of numerous studies, general treatment of the H.pylori infection to prevent gastric carcinoma is cost efficient, as itwould prevent over 95% of cases (Graham & Shiotani, 2005). Therapy isclearly indicated for patients with gastric ulcers, precancerous ordefinitive gastric cancer, relatives of gastric cancer patients, as wellas patients requiring long-term therapy with non-steroidalanti-inflammatory drugs (including aspirin for cardiovascular diseases).Due to high gastric cancer rates in Japan, the treatment of allindividuals infected with H. pylori is recommended there, despitesteadily increasing antibiotic resistance rates (Shiota et al., 2010).

The standard therapy of infections caused by H. pylori to date consistsof two antibiotics combined with a proton pump inhibitor such asomeprazole. The cost of a one-week treatment is approximately EUR 200per patient. This therapy has significant side effects in some patientsand leads to a steep increase in resistant pathogens. Because second-and third-line therapies often fail, about 10% of all patients can nolonger be treated today (Gao et al., 2010), which could rise to anestimated 60% by 2020.

Furthermore, an increasing number of Helicobacter species (other than H.pylori) that colonize the enterohepatic tract of animals and humans havebeen identified in recent years and suggested to be involved in variousdiseases (Fox, 2002). For example, H. bilis has been associated withdiseases such as cholecystitis, gallbladder cancer and biliary tractmalignancies (Fox et al., 1998; Matsukura et al., 2002; Pisani et al.,2008).

Thus, there is a need for novel therapeutic approaches for preventing ortreating diseases or disorders caused by or associated withHelicobacter, e.g., H. pylori or H. bilis. For example, if a vaccineagainst H. pylori were available, it would benefit millions of patientsand reduce healthcare costs significantly. Vaccines are highly effectivein combating prevalent infectious diseases. In fact, the U.S. Center ofDisease Control called vaccination the most effective method forpreventing infectious diseases (U.S. CDC, 2011). However, to date, thereis no effective vaccine for humans against H. pylori available. Whendesigning a vaccine, target screening and selection is detrimental tosuccessfully achieving pan protection (Gómez-Gascón et al., 2012).Optimal antigens for vaccination should not only be conserved but alsobe essential for colonization, maintenance of infection, orpathogenicity. Therefore, antigens which enable direct interaction ofbacteria with its host could provide preferred targets for vaccinationand therapy in general.

SUMMARY OF THE INVENTION

In one aspect, the present invention relates to an inhibitor of theinteraction between Helicobacter pylori HopQ and a member of thecarcinoembryonic antigen-related cell adhesion molecule (CEACAM) familyfor use in a method of preventing or treating a disease or disordercaused by or associated with H. pylori.

In one embodiment, the inhibitor inhibits binding of H. pylori HopQ tothe member of the CEACAM family and/or HopQ-CEACAM-mediated signaling.

In one embodiment, the inhibitor inhibits binding of H. pylori HopQ tothe member of the CEACAM family, preferably to an extracellular domainof the member of the CEACAM family, more preferably to the N-domain ofthe member of the CEACAM family.

In one embodiment, the member of the CEACAM family is expressed on thesurface of epithelial cells, endothelial cells and/or immune cells.

In one embodiment, the member of the CEACAM family is selected from thegroup consisting of human CEACAM family members, non-human primateCEACAM family members and rat CEACAM family members.

In one embodiment, the member of the CEACAM family is selected from thegroup consisting of CEACAM1, CEACAM3, CEACAM5 and CEACAM6.

In one embodiment, H. pylori HopQ is a type I HopQ protein or a type IIHopQ protein.

In one embodiment, the inhibitor is selected from the group consistingof

(a) (poly-)peptide ligands or peptidomimetic ligands binding to H.pylori HopQ, preferably to an extracellular domain of H. pylori HopQ;

(b) (poly-)peptide ligands or peptidomimetic ligands binding to themember of the CEACAM family, preferably to an extracellular domain ofthe member of the CEACAM family, more preferably to the N-domain of themember of the CEACAM family;

(c) nucleic acid molecules encoding the (poly-)peptide ligands of (a)and (b);

(d) nucleic acid ligands binding to H. pylori HopQ, preferably to anextracellular domain of H. pylori HopQ;

(e) nucleic acid ligands binding to the member of the CEACAM family,preferably to an extracellular domain of the member of the CEACAMfamily, more preferably to the N-domain of the member of the CEACAMfamily;

(f) inhibitory nucleic acid molecules inhibiting the expression of themember of the CEACAM family or of H. pylori HopQ;

(g) small molecules binding to H. pylori HopQ, preferably to anextracellular domain of H. pylori HopQ; and

(h) small molecules binding to the member of the CEACAM family,preferably to an extracellular domain of the member of the CEACAMfamily, more preferably to the N-domain of the member of the CEACAMfamily.

In one embodiment, the (poly-)peptide ligands are selected from thegroup consisting of antibodies, antibody derivatives, antibody mimetics,peptide aptamers and soluble fragments of the member of the CEACAMfamily or of H. pylori HopQ.

In one embodiment, the peptidomimetic ligands are selected from thegroup consisting of peptoids, beta-peptides and D-peptides.

In one embodiment, the nucleic acid ligands are selected from the groupconsisting of DNA aptamers, RNA aptamers and XNA aptamers.

In one embodiment, the inhibitory nucleic acid molecules are selectedfrom the group consisting of siRNAs, shRNAs, miRNAs and antisense DNA orRNA molecules.

In one embodiment, the extracellular domain of H. pylori HopQ is theinsertion domain of H. pylori HopQ.

In one embodiment, the extracellular domain of H. pylori HopQ is loop A,loop B, loop C or loop D of H. pylori HopQ, wherein

loop A is located between helix H3 and strand S1 of H. pylori HopQ;

loop B is located between strand S2 and helix H4 of H. pylori HopQ;

loop C is located between helix H5 and helix H6 of H. pylori HopQ; and

loop D is located between helix H7 and helix H8 of H. pylori HopQ.

In one embodiment, the inhibitor is comprised in a pharmaceuticalcomposition.

In one embodiment, the disease or disorder caused by or associated withH. pylori is selected from the group consisting of H. pylori infectionand gastroduodenal disorders caused by H. pylori.

In one embodiment, the gastroduodenal disorders caused by H. pylori areselected from the group consisting of gastritis, chronic gastritis,gastric atrophy, gastric or duodenal ulcer, stomach cancer and MALTlymphoma.

In another aspect, the present invention relates to an in vitro methodfor identifying a drug candidate for preventing or treating a disease ordisorder caused by or associated with H. pylori, the method comprising

(a) contacting (i) a CEACAM protein or a functional fragment thereofwith (ii) a H. pylori HopQ protein or a functional fragment thereof and(iii) a test compound, and

(b) determining whether the test compound inhibits the interactionbetween the CEACAM protein or the functional fragment thereof and the H.pylori HopQ protein or the functional fragment thereof, wherein a testcompound inhibiting the interaction between the CEACAM protein or thefunctional fragment thereof and the H. pylori HopQ protein or thefunctional fragment thereof is identified as a drug candidate forpreventing or treating a disease or disorder caused by or associatedwith H. pylori.

In one embodiment, step (b) comprises determining whether the testcompound inhibits binding of the H. pylori HopQ protein or thefunctional fragment thereof to the CEACAM protein or the functionalfragment thereof, wherein, preferably, the functional fragment of the H.pylori HopQ protein comprises an extracellular domain or a fragmentthereof, and/or the functional fragment of the CEACAM protein comprisesan extracellular domain or a fragment thereof, preferably the N-domain,and/or determining whether the test compound inhibitsHopQ-CEACAM-mediated signaling.

In one embodiment, the CEACAM protein is selected from the groupconsisting of human CEACAM proteins, non-human primate CEACAM proteinsand rat CEACAM proteins.

In one embodiment, the CEACAM protein is selected from the groupconsisting of CEACAM1, CEACAM3, CEACAM5 and CEACAM6.

In one embodiment, the H. pylori HopQ protein is a type I HopQ proteinor a type II HopQ protein.

In one embodiment, the extracellular domain of H. pylori HopQ is theinsertion domain of H. pylori HopQ or a functional fragment thereof.

In one embodiment, the extracellular domain of H. pylori HopQ is loop A,loop B, loop C or loop D of H. pylori HopQ or a functional fragment ofany of the foregoing, wherein

loop A is located between helix H3 and strand S1 of H. pylori HopQ;

loop B is located between strand S2 and helix H4 of H. pylori HopQ;

loop C is located between helix H5 and helix H6 of H. pylori HopQ; and

loop D is located between helix H7 and helix H8 of H. pylori HopQ.

In one embodiment, the extracellular domain of H. pylori HopQ is loop A,loop B or loop C of H. pylori HopQ or a functional fragment of any ofthe foregoing.

In one embodiment, the test compound is selected from the groupconsisting of (poly-)peptides, peptidomimetics, nucleic acid moleculesand small molecules.

In another aspect, the present invention relates to the use of a CEACAMprotein or a functional fragment thereof being able to interact with H.pylori HopQ for studying H. pylori infection or identifying a drugcandidate for preventing or treating a disease or disorder caused by orassociated with H. pylori.

In a further aspect, the present invention relates to the use of a cellheterologously expressing a CEACAM protein or a functional fragmentthereof being able to interact with H. pylori HopQ for studying H.pylori infection or identifying a drug candidate for preventing ortreating a disease or disorder caused by or associated with H. pylori.

In yet another aspect, the present invention relates to the use of anon-human transgenic animal heterologously expressing a CEACAM proteinor a functional fragment thereof being able to interact with H. pyloriHopQ for studying H. pylori infection or identifying a drug candidatefor preventing or treating a disease or disorder caused by or associatedwith H. pylori.

In one embodiment of the above uses, the CEACAM protein is selected fromthe group consisting of human CEACAM proteins, non-human primate CEACAMproteins and rat CEACAM proteins.

In one embodiment, the CEACAM protein is selected from the groupconsisting of CEACAM1, CEACAM3, CEACAM5 and CEACAM6.

In one embodiment of the above method or uses, the disease or disordercaused by or associated with H. pylori is selected from the groupconsisting of H. pylori infection and gastroduodenal disorders caused byH. pylori.

In one embodiment, the gastroduodenal disorders caused by H. pylori areselected from the group consisting of gastritis, chronic gastritis,gastric atrophy, gastric or duodenal ulcer, stomach cancer and MALTlymphoma.

In another aspect, the present invention relates to an inhibitor of theinteraction between H. pylori HopQ and a member of the carcinoembryonicantigen-related cell adhesion molecule (CEACAM) family, wherein theinhibitor is selected from the group consisting of

(a) (poly-)peptide ligands or peptidomimetic ligands binding to anextracellular domain of H. pylori HopQ;

(b) (poly-)peptide ligands or peptidomimetic ligands binding to theN-domain of the member of the CEACAM family;

(c) nucleic acid molecules encoding the (poly-)peptide ligands of (a)and (b);

(d) nucleic acid ligands binding to an extracellular domain of H. pyloriHopQ;

(e) nucleic acid ligands binding to the N-domain of the member of theCEACAM family;

(f) inhibitory nucleic acid molecules inhibiting the expression of themember of the CEACAM family or of H. pylori HopQ;

(g) small molecules binding to an extracellular domain of H. pyloriHopQ; and

(h) small molecules binding to the N-domain of the member of the CEACAMfamily.

In one embodiment, the (poly-)peptide ligands are selected from thegroup consisting of antibodies, antibody derivatives, antibody mimetics,peptide aptamers and soluble fragments of the member of the CEACAMfamily or of H. pylori HopQ.

In one embodiment, the peptidomimetic ligands are selected from thegroup consisting of peptoids, beta-peptides and D-peptides.

In one embodiment, the nucleic acid ligands are selected from the groupconsisting of DNA aptamers, RNA aptamers and XNA aptamers.

In one embodiment, the inhibitory nucleic acid molecules are selectedfrom the group consisting of siRNAs, shRNAs, miRNAs and antisense DNA orRNA molecules.

In one embodiment, the extracellular domain of H. pylori HopQ is theinsertion domain of H. pylori HopQ.

In one embodiment, the extracellular domain of H. pylori HopQ is loop A,loop B, loop C or loop D of H. pylori HopQ, wherein

loop A is located between helix H3 and strand S1 of H. pylori HopQ;

loop B is located between strand S2 and helix H4 of H. pylori HopQ;

loop C is located between helix H5 and helix H6 of H. pylori HopQ; and

loop D is located between helix H7 and helix H8 of H. pylori HopQ.

In one embodiment, the (poly-)peptide ligands or peptidomimetic ligandsare selected from soluble fragments of the member of the CEACAM familyor of H. pylori HopQ and peptidomimetic variants thereof, respectively.

In one embodiment, the soluble fragments of H. pylori HopQ comprise theinsertion domain of H. pylori HopQ or a functional fragment thereof.

In one embodiment, the soluble fragments of H. pylori HopQ comprise loopA, loop B, loop C or loop D of H. pylori HopQ or a functional fragmentof any of the foregoing, wherein

loop A is located between helix H3 and strand S1 of H. pylori HopQ;

loop B is located between strand S2 and helix H4 of H. pylori HopQ;

loop C is located between helix H5 and helix H6 of H. pylori HopQ; and

loop D is located between helix H7 and helix H8 of H. pylori HopQ.

In one embodiment, the member of the CEACAM family is selected from thegroup consisting of human CEACAM family members, non-human primateCEACAM family members and rat CEACAM family members.

In one embodiment, the member of the CEACAM family is selected from thegroup consisting of CEACAM1, CEACAM3, CEACAM5 and CEACAM6.

In yet another aspect, the present invention relates to an immunogeniccomposition comprising

(a) at least one isolated (poly-)peptide comprising (i) the amino acidsequence of H. pylori HopQ; or (ii) an immunogenic variant thereof; or(iii) an immunogenic fragment of (i) or (ii); or

(b) at least one nucleic acid molecule encoding an isolated(poly-)peptide according to item (a).

In one embodiment, the isolated (poly-)peptide is a recombinant(poly-)peptide.

In one embodiment, the immunogenic fragment comprises an extracellulardomain of H. pylori HopQ.

In one embodiment, the extracellular domain of H. pylori HopQ is theinsertion domain of H. pylori HopQ or a functional fragment thereof.

In one embodiment, the extracellular domain of H. pylori HopQ is loop A,loop B, loop C or loop D of H. pylori HopQ or a functional fragment ofany of the foregoing, wherein

loop A is located between helix H3 and strand S1 of H. pylori HopQ;

loop B is located between strand S2 and helix H4 of H. pylori HopQ;

loop C is located between helix H5 and helix H6 of H. pylori HopQ; and

loop D is located between helix H7 and helix H8 of H. pylori HopQ.

In one embodiment, the isolated (poly-)peptide is a fusion protein.

In one embodiment, the nucleic acid molecule is DNA or RNA, wherein,preferably, the nucleic acid molecule is contained in a vector.

In one embodiment, the immunogenic composition further comprises atleast one adjuvant.

In one embodiment, the immunogenic composition is a vaccine.

In one embodiment, the immunogenic composition elicits an immuneresponse comprising the secretion of antibodies, wherein, preferably,the antibodies inhibit the interaction between H. pylori HopQ and amember of the carcinoembryonic antigen-related cell adhesion molecule(CEACAM) family.

In a further aspect, the present invention relates to an immunogeniccomposition as defined above for use as a medicament.

In yet another aspect, the present invention relates to an immunogeniccomposition as defined above for use in a method of preventing ortreating a disease or disorder caused by or associated with H. pylori,wherein, preferably, the disease or disorder is selected from the groupconsisting of H. pylori infection and gastroduodenal disorders caused byH. pylori.

In one embodiment, the gastroduodenal disorders are selected from thegroup consisting of gastritis, chronic gastritis, gastric or duodenalulcer, stomach cancer and MALT lymphoma.

In another aspect, the present invention relates to a CEACAM protein ora functional fragment thereof being able to interact with H. pylori HopQfor use in a method of preventing or treating a disease or disordercaused by or associated with H. pylori, wherein the CEACAM protein orfunctional fragment thereof is attached to a solid support, preferably anon-cellular solid support.

In one embodiment, the disease or disorder is selected from the groupconsisting of H. pylori infection and gastroduodenal disorders caused byH. pylori, wherein, preferably, the gastroduodenal disorders areselected from the group consisting of gastritis, chronic gastritis,gastric or duodenal ulcer, stomach cancer and MALT lymphoma.

In one embodiment, the CEACAM protein is selected from the groupconsisting of CEACAM1, CEACAM3, CEACAM5 and CEACAM6.

In one embodiment, the solid support is a microsphere.

DESCRIPTION OF THE FIGURES

FIG. 1 shows that H. pylori employs the N-terminal domain of hu-CEACAM1and binds CEACAM5 and CEACAM6 but not CEACAM8. Pull down experiments oflive H. pylori and (a) hu-CEACAM1-Fc and (b) hu-CEACAM5-Fc,hu-CEACAM6-Fc or hu-CEACAM8-Fc, respectively, were analyzed by westernblot and flow cytometry (n=3). (c) IHC staining of human normal stomach,gastritis and gastric cancer for CEACAM1, CEACAM5 and CEACAM6. Scalebars, 50 μm. (d) hu-CEACAM1AN-Fc was detected by western blot or cellswere stained with α-hu-IgG-FITC and the fluorescence intensity ofbacteria was analyzed by flow cytometry. (e) H. pylori incubated withGFP-tagged CEACAM1 variants analyzed by flow cytometry and the ratio ofCEACAM variants binding to bacteria was measured. One-way ANOVA, Pvalue=0.009, n. s.: not significant. Error bars indicate s.e.m. (f) Pulldown experiments of H. pylori strains incubated with de-glycosylatedhu-CEACAM1-Fc.

FIG. 2 shows that Hu-CEACAM1 employment by human pathogens is highlyselective. Binding quantification of different H. pylori strains andother bacteria to the CEACAM family members. (a, c and f) H. pyloristrains, Moraxella catarrhalis, Moraxella lacunata and Campylobacterjejuni were incubated with hu-CEACAM1, 3, 5, 6 and 8-Fc. After washing,bacteria were lysed and proteins were subjected to SDS-gel/western blotand detected with corresponding antibodies, or (b, d and g) were stainedwith anti-hu-IgG-FITC and the fluorescence intensity of bacteria wasanalyzed by flow cytometry (3 technical replicates). One-way ANOVA, n.s.: not significant. Error bars indicate s.e.m. (e) Scoring of theCEACAM expression in stomach biopsies of naïve healthy individuals andH. pylori positive gastritis. (h) The amino acid sequences of N-terminaldomains of the hu-CEACAM1 (P13688; SEQ ID NO: 28), CEACAM5 (P06731; SEQID NO: 29), CEACAM6 (P40199; SEQ ID NO: 30) and CEACAM8 (P31997; SEQ IDNO: 31) were compared. (i) SDS-PAGE showing Coomassie stain of purifiedhu-CEACAM1, 1ΔN, 6 and 8-FC expression.

FIG. 3 shows H. pylori binding to CEACAM1 orthologues. (a) SolubleGFP-tagged CEACAMs from different species were incubated with H. pyloriand fluorescence was determined by flow cytometry (3 technicalreplicates). Bacterial pull-down using (b) rat-CEACAM1-Fc (c) andrat-CEACAM1ΔN-Fc was detected by western blot, or (d) stained withα-Hu-IgG-FITC and analyzed by flow cytometry. (e) Representativeconfocal images of H. pylori binding to human, rat and mouseCEACAM1-expressing CHO cells. Untransfected CHO served as control. Scalebars: left-hand panels, 25 μm, wright-hand panels, 10 μm. (f) Pull downof whole cell lysates of untransfected, human-, mouse- and ratCEACAM1-transfected CHO cells incubated with H. pylori. After washing,cells were lysed and proteins were subjected to SDS-gel/western blot anddetected with corresponding α-CEACAM1 antibodies.

FIG. 4 relates to CEACAM1 orthologues and non pylori helicobacters. (a)The amino acid sequences of N-terminal domains of the human CEACAM1(P13688; SEQ ID NO: 28), murine CEACAM1 (P31809; SEQ ID NO: 33) and ratCEACAM1 (P16573; SEQ ID NO: 32) were compared. Amino acids identical inthe human and rat, but different to mouse-CEACAM1 sequences, areindicated by arrows. (b) Live non-pylori strains were incubated withhu-CEACAM1-Fc, CEACAM5-Fc, CEACAM6-Fc, CEACAM8-Fc and CEACAM1ΔN-Fc.After rigorous washing, bacteria were lysed and proteins were separatedon SDS-gel and detected with corresponding antibodies. (c) Afterbacterial pull-down and anti-hu-IgG-FITC staining, the ratio offluorescence intensity of bacteria was analyzed by flow cytometry (3technical replicates). One-way ANOVA, *: P=0.03, ***: P=0.0001, n. s.:not significant. (d) Scheme of bacterial pull down for analysis of H.pylori-CEACAM interaction.

FIG. 5 shows that H. pylori binds to CEACAM1 via HopQ. (a) Pull down ofvarious H. pylori knockout strains incubated with hu-CEACAM1-Fc. (b)Whole lysate of H. pylori strain G27 was incubated with hu-CEACAM1-Fcand precipitated with protein G sepharose. For mass spec analysisproteins were denatured, trypsin digested, the peptides analyzed viaMS/MS and subsequently searched against the H. pylori G27 proteome. Aselection of outer membrane proteins identified is shown. HopQ and HopZ,showing high Sequest scores, were further analyzed. (c) Pull down andwestern blot and FACS analysis of H. pylori strains P12, P12ΔhopQ andP12ΔhopZ binding to hu-CEACAM1-, CEACAM5- and CEACAM6-Fc.

FIG. 6 relates to the identification of HopQ as hu-CEACAM interactionpartner of H. pylori. (a) Whole lysate of H. pylori strain G27 wasincubated with hu-CEACAM1-Fc and precipitated with protein G sepharose.For mass spectrometry analysis proteins were denatured, trypsindigested, the peptides analyzed via MS/MS and subsequently searchedagainst the H. pylori G27 proteome. (b) CHO-CEACAM1, AGS, MKN45 andMKN28 were incubated with myc-His-tagged HopQ and subsequently with antic-myc mAb followed by FITC conjugated goat anti-mouse F(ab′)2. Inparallel, the presence of CEACAMs was controlled by staining withrabbit-anti-CEA pAb (Dianova). Background fluorescence was measured byincubating the cells with control IgG antibody instead of HopQ proteinor primary antibody (thin line). The samples were analyzed by flowcytometry. (c) Indicated CHO transfectants were incubated with HopQ andanti-CEA pAb as described above. Subsequently, samples were analyzed byflow cytometry (n=3). (d) The hopQ genes were collected from H. pyloriisolates of all continents (NCBI database http://www.ncbi.nlm.nih.gov/).The MEGA6 program was applied to infer DNA relatedness using theNeighbor-Joining method. The Maximum Composite Likelihood method wasutilized to compute evolutionary distances. The hopQ genes grouped intotwo major allelic variants (type I and II). The type I alleles are morediverse and were further divided into the two subgroupings type Ia andIb, as indicated.

FIG. 7 shows the X-ray structure and binding properties of the HopQadhesin domain. (a) Ribbon representation of the HopQ^(AD) showing the3+4-helix bundle topology seen also in the BabA and SabA adhesins (FIG.8d ). Three Cys pairs (Cys102-Cys131, Cys237-Cys269 and Cys361-Cys384)conserved in most Hop family members pinch off extended loops at thedistal end of the HopQ adhesin domain, to form a common protein surfacearea with increased sequence diversity. Similar to the 4-strandedinsertion domain of BabA (BabA-ID; FIG. 8d ), which houses the adhesin'scarbohydrate binding site, HopQ^(AD) holds a beta-hairpin insertiondomain (HopQ-ID) between helices H4 and H5. (b) Mean ELISA titers (n=4;±s.d.) of HopQ^(AD) or mutant HopQ^(AD) lacking the HopQ-ID(HopQ^(AD)ΔID) binding to increasing concentrations of C1ND. Loss of theHopQ-ID results in a ˜10-fold reduction in binding affinity. (c) SDS andnative page of C1ND stained with Coomassie-blue (“C”) or with HopQ^(AD)in a far western blot (“HopQ”) experiment. SDS and native-PAGE showsthree glycosylation forms of C1ND in addition to the non-glycosylatedprotein (lower band). HopQ^(AD) selectively binds the C1ND undernon-denaturing conditions, demonstrating the implication of a strongprotein-protein component in the HopQ-CEACAM interaction.

FIG. 8 shows isothermal titration calorimetry (ITC) of HopQ^(AD)-bindingto the human CEACAM1 N-domain. ITC injection heats (upper) andnormalized binding isotherm (lower) of 25 μM C1ND (a) or E. coliexpressed C1ND (Ec-C1ND) (b) titrated with 250 μM HopQ^(AD) show anequivalent equimolar interaction in presence or absence ofN-glycosylation, respectively. Binding affinities and thermodynamicprofiles are shown inset. (c) 2mFo-DFc electron density map contoured at1.0 σ around the H5 helix of HopQ^(AD). (d) Superimposition of thestructures of BabA₁₋₅₂₇ (PDB accession code 4ZH0), HopQ^(AD) andSabA₁₋₄₆₀ (PDB accession code 4O5J). Both the BabA and SabA structuresshow a kink in their N-terminal end to position them perpendicular tothe core domain, however this change in orientation is missing in theHopQ structure. The α-helical core domain is conserved across allstructures, whereas the 2-stranded insertion domain (ID) in HopQ iselongated by two additional β-strands in BabA. Previously, it was shownthe ID of BabA to be responsible for adherence to blood group receptors.Strands and helices are named according to HopQ topology. (e) SDS-PAGEand schematic representation of the HopQ^(AD) and HopQ^(AD)ΔID fragmentsused in this study. (f) Mean ELISA titers (n=4; ±s.d.) of HopQ^(AD) ormutant HopQ^(AD) lacking the HopQ-ID (HopQ^(AD)ΔID) binding toincreasing concentrations of CEACAM5 or 8.

FIG. 9 shows that deletion of hopQ in H. pylori leads to reducedbacterial cell adhesion and abrogates CagA delivery, IL-8 release andcell elongation. (a) Flow cytometry analysis of CHO-hu-CEACAM1-L, MKN45and AGS cells incubated with MOI 10 of CFSE-DA labeled bacterial strainsP12, G27, P12ΔhopQ, and G27ΔbabAΔsabA (3 technical replicates).Mean±s.e.m are shown. Two-tailed t-test, *P≤0.03. (b) CHO-CEACAM1-Lcells were incubated with and without H. pylori. Subsequently theTyr-phosphorylation of CEACAM1 was analyzed by IP and western blot.Pervanadate treatment served as positive control, detection of CEACAM1as loading control (bottom). (c) AGS cells were infected with P12,NCTC11637 and corresponding isogenic hopQ-mutants. The blot was probedwith α-phosphotyrosine and α-CagA. (d) Generation of IL-8 by AGSdetermined by ELISA. (e) HA-tagged HEK293-hu-CEACAM1 transfectantsinfected with indicated H. pylori wt and knockout strains orNCTC11637ΔhopQ re-expressing wt hopQ gene. (f) Representative phasecontrast micrographs of differently infected AGS. (g) AGS cells infectedfor 6 h with the P12, P12ΔhopQ or P12ΔhopQ/hopQ re-expressing wt hopQgene (3 technical replicates). (h) AGS cells were pre-treated with 2, 5,10 or 20 μg of α-CEACAM Ab per 4×10⁵ cells (lanes 3-6). After 30 minincubation, MOI 20 of wild-type H. pylori was added to the cells. (i)Wild-type H. pylori was pre-treated with 2, 5, 10 or 20 μg of α-HopQ per8×10⁶ bacteria (lanes 3-6) and then added to the AGS cells. After 6 h ofinfection, the cells were photographed and harvested, followed byimmunoblotting with α-PY99 and α-CagA. The bottom panels show thequantification of elongated AGS cells in each experiment in fivedifferent 0.25-mm² fields (3 technical replicates). Error bars showmean±s.d. (j) Pre-incubation of cells with a HopQ-derived peptidecorresponding to the HopQ-ID (aa 190-218) inhibits HopQ-dependentphosphorylation of CagA and cell elongation at low micromolarconcentration.

FIG. 10 shows characterization of the CEACAM expression pattern and CagAphosphorylation in gastric cell lines. The gastric cell lines indifferent cell growth stages were stained with mAb for hu-CEACAM1,CEACAM5 and CEACAM6 and either (a) stained by FITC-conjugated secondaryantibody and subsequently, CEACAM cell surface expression was monitoredby flow cytometry or (b) cell lysates were subjected to SDS-gel/westernblot and detected with corresponding antibodies. (c) AGS cells wereinfected with wt H. pylori strain P12 and various isogenic mutants ofimportant adhesins (BabA, SabA and OipA or the double mutant BabA/SabA).Cells were infected for 6 hours using MOI 50. The blot was probed withthe α-PY-99. (d) HEK293 cells were transfected with vector control,followed by MOI 50 infection for 6 hours with indicated cagPAI-positiveH. pylori strains P12, NCTC11637 and the cagPAI-negative strain Ka89.(e) HEK293 cells were transfected with indicated CEACAM expressionvectors for 48 hours, followed by MOI 50 infection for 6 hours with wtH. pylori strain NCTC11637. Anti-CagA detection served as control forequal bacteria loading. Anti-GAPDH detection served as cell lysateloading control. (f) CHO-hu-CEACAM1-4L were transfected with indicatedluciferase reporter constructs for the transcription factors Myc, STAT3,CreATF2/CREB, GRE and as negative control pTAL-Luciferase. Thentransfected cells were infected with H. pylori wt, isogenic hopQdeletion mutant or left untreated followed by measurement of luciferaseactivities as Relative Light Units (RLU) as indicated (n=3). (g)Pre-incubation of AGS cells with a HopQ^(AD), but not the HopQ-IDdeletion mutant (HopQ^(AD)ΔID) inhibits P12-induced phosphorylation ofCagA at submicromolar concentrations, as well as the cell elongation.Similarly, pre-incubation with the HopQ-ID peptide (aa 190-218; see FIG.9j ) blocks P12-induced phosphorylation of CagA, albeit at ˜10 to 20fold higher concentrations compared to the full HopQ^(AD).

FIG. 11 shows that H. pylori colonization of rat stomach depends onHopQ. (a) IHC staining of rat stomach for rat-CEACAM1. (b) Male Spraguedawley rats (Data is from one experiment with 8 rats per group) wereorally infected two times with SS1 and SS1ΔhopQ strains. Mean±s.e.m areshown. Two-tailed t-test, * P=0.02. (c) Hematoxylin/eosin staining ofinfected rat stomachs.

FIG. 12 shows that only the SS1 strain of H. pylori can colonize ratstomachs. (a) Pull down experiments with H. pylori wt strain SS1,SS1ΔhopQ, SS1ΔhopQ re-expressing wt hopQ gene and hu-CEACAM1-Fc andrat-CEACAM1-Fc analyzed by flow cytometry and western blot. (b)Expression of rat-CEACAM1 in RNA isolated of rat stomach biopsy. NTC: notemplate control, NEC: no enzyme control.

FIG. 13(a) shows the X-ray structure of the HopQ adhesin domain(HopQ^(AD)) bound to the N-terminal domain of human CEACAM1(huCEACAM1-ND). The HopQ loops forming the contact interface with theCEACAM1-ND comprise residues 123-136 (loop A), residues 152-180 (loop B)and residues 258-290 (loop C) of SEQ ID NO: 15 (HopQ of strain P12). TheHopQ insertion domain (see, for example, residues 210 to 238 of SEQ IDNO: 1) and loop 371-407 (loop D) of SEQ ID NO: 15 are adjacent to thedirect binding interface. Antibodies raised against peptides layinginside or adjacent to the CEACAM-binding interface will have aneutralizing action, inhibiting the HopQ-CEACAM association by sterichindrance. (b) Representative sequences as found in H. pylori strain P12as well as consensus sequences for the four loops. The consensussequences are based on a multiple sequence alignment of 87representative HopQ alleles from different clinical H. pylori isolates,wherein the height of the bars above the individual amino acids indicatethe degree of identity among HopQ alleles. Sequence conservation logosshow the possible amino acid sequence variation in the respective loops,wherein the height of the amino acid single letter symbol isrepresentative of its probability.

DETAILED DESCRIPTION OF THE INVENTION

Although the present invention is described in detail above and below,it is to be understood that this invention is not limited to theparticular methodologies, protocols and reagents described herein asthese may vary. It is also to be understood that the terminology usedherein is for the purpose of describing particular embodiments only, andis not intended to limit the scope of the present invention, which willbe limited only by the appended claims. Unless defined otherwise, alltechnical and scientific terms used herein have the same meanings ascommonly understood by one of ordinary skill in the art.

In the following, certain elements of the present invention will bedescribed. These elements may be listed with specific embodiments,however, it should be understood that they may be combined in any mannerand in any number to create additional embodiments. The variouslydescribed examples and preferred embodiments should not be construed tolimit the present invention to only the explicitly describedembodiments. This description should be understood to support andencompass embodiments, which combine the explicitly describedembodiments with any number of the disclosed and/or preferred elements.Furthermore, any permutations and combinations of all described elementsin this application should be considered disclosed by the description ofthe present application unless the context indicates otherwise.

Preferably, the terms used herein are defined as described in “Amultilingual glossary of biotechnological terms (IUPACRecommendations)”, H. G. W. Leuenberger, B. Nagel, and H. Kölbl, Eds.,Helvetica Chimica Acta, CH-4010 Basel, Switzerland, (1995).

The practice of the present invention will employ, unless otherwiseindicated, conventional methods of chemistry, biochemistry, cellbiology, immunology, and recombinant DNA techniques which are explainedin the literature in the field (cf., e.g., Molecular Cloning: ALaboratory Manual, 3^(rd) Edition, J. Sambrook et al. eds., Cold SpringHarbor Laboratory Press, Cold Spring Harbor 2000).

Throughout this specification and the claims which follow, unless thecontext requires otherwise, the word “comprise”, and variations such as“comprises” and “comprising”, will be understood to imply the inclusionof a stated member, integer or step or group of members, integers orsteps but not the exclusion of any other member, integer or step orgroup of members, integers or steps although in some embodiments suchother member, integer or step or group of members, integers or steps maybe excluded, i.e. the subject-matter consists in the inclusion of astated member, integer or step or group of members, integers or steps.The terms “a” and “an” and “the” and similar reference used in thecontext of describing the invention (especially in the context of theclaims) are to be construed to cover both the singular and the plural,unless otherwise indicated herein or clearly contradicted by context.Recitation of ranges of values herein is merely intended to serve as ashorthand method of referring individually to each separate valuefalling within the range. Unless otherwise indicated herein, eachindividual value is incorporated into the specification as if it wereindividually recited herein. All methods described herein can beperformed in any suitable order unless otherwise indicated herein orotherwise clearly contradicted by context. The use of any and allexamples, or exemplary language (e.g., “such as”), provided herein isintended merely to better illustrate the invention and does not pose alimitation on the scope of the invention otherwise claimed. No languagein the specification should be construed as indicating any non-claimedelement essential to the practice of the invention.

Several documents are cited throughout the text of this specification.Each of the documents cited herein (including all patents, patentapplications, scientific publications, manufacturer's specifications,instructions, etc.), whether supra or infra, are hereby incorporated byreference in their entirety. Nothing herein is to be construed as anadmission that the invention is not entitled to antedate such disclosureby virtue of prior invention.

H. pylori specifically colonizes the human gastric epithelium and is themajor causative agent for ulcer disease and gastric cancer development.The inventors have identified members of the carcinoembryonicantigen-related cell adhesion molecule (CEACAM) family as importantreceptors of all human H. pylori isolates and show that HopQ is a novelsurface-exposed adhesin that specifically binds human CEACAM1, CEACAM3,CEACAM5 and CEACAM6. H. pylori binding to the CEACAM1 N-domain inducesCEACAM1-mediated signaling, and the HopQ-CEACAM1 interaction enablestranslocation of the virulence factor CagA into host cells, permitscolonization in the rat infection model and enhances the release ofpro-inflammatory mediators such as interleukin-8. Based on the crystalstructures of HopQ and a HopQ-CEACAM complex, the inventors have foundthat a beta-hairpin insertion domain in HopQ's extracellular 3+4 helixbundle domain and four specific loop regions are implicated in CEACAMbinding. A peptide derived from the insertion domain competitivelyinhibits HopQ-mediated activation of the CagA virulence pathway, as doesgenetic or antibody-mediated abrogation of HopQ function. Together, thepresent invention identifies the HopQ-CEACAM interaction as noveltherapeutic target to combat H. pylori associated diseases.

The present invention provides an inhibitor of the interaction betweenH. pylori HopQ and a member of the carcinoembryonic antigen-related celladhesion molecule (CEACAM) family for use in a method of preventing ortreating a disease or disorder caused by or associated with H. pylori.

The present invention further provides the use of an inhibitor of theinteraction between H. pylori HopQ and a member of the CEACAM family inthe preparation of a medicament for preventing or treating a disease ordisorder caused by or associated with H. pylori.

The present invention further provides a method of preventing ortreating a disease or disorder caused by or associated with H. pylori ina subject, said method comprising administering an inhibitor of theinteraction between H. pylori HopQ and a member of the CEACAM family tothe subject.

According to the present invention, a disease or disorder caused by orassociated with H. pylori is preferably selected from the groupconsisting of H. pylori infection and gastroduodenal disorders caused byH. pylori.

The term “infection”, as used herein, refers to the invasion of asubject's body tissues by disease-causing agents (e.g., H. pylori),their multiplication, and the reaction of the tissues to these agentsand the toxins they produce.

The term “gastroduodenal disorder” (or simply “stomach disorder”), asused herein, refers to a disorder affecting the stomach and theadjoining duodenum. “Gastroduodenal disorders caused by H. pylori” areknown to a person skilled in the art and include, for example,gastritis, chronic gastritis, gastric atrophy, gastric or duodenalulcer, stomach cancer (also referred to as gastric cancer) and MALTlymphoma.

The term “subject”, as used herein, relates to any organism such as avertebrate, particularly any mammal, including both a human and anothermammal, e.g., an animal such as a rodent, a rabbit, a cow, a sheep, ahorse, a dog, a cat, a lama, a pig, or a non-human primate (e.g., amonkey). The rodent may be a mouse, rat, hamster, guinea pig, orchinchilla. In one embodiment, the subject is a human, a rat or anon-human primate. Preferably, the subject is a human. In oneembodiment, a subject is a subject with or suspected of having a diseaseor disorder, in particular a disease or disorder as disclosed herein,also designated “patient” herein.

The term “preventing”, as used herein, may refer to stopping/inhibitingthe onset of a disease or disorder (e.g., by prophylactic treatment). Itmay also refer to a delay of the onset, reduced frequency of symptoms,or reduced severity of symptoms associated with the disease or disorder(e.g., by prophylactic treatment).

The term “treating”, as used herein, relates to any treatment whichimproves the health status and/or prolongs (increases) the lifespan of apatient.

The term “medicament”, as used herein, refers to a substance/compositionused in therapy, i.e., in the prevention or treatment of a disease ordisorder. According to the invention, the terms “disease” or “disorder”refer to any pathological state, in particular to the diseases ordisorders as defined herein.

The carcinoembryonic antigen-related cell adhesion molecule (CEACAM)family is a well-known family of immunoglobulin-related vertebrateglycoproteins (see, for example, Tchoupa et al., 2014). Members of theCEACAM family typically comprise an N-terminal extracellular Igv-likedomain, which may be followed by up to six extracellular Ig_(C2)-likedomains, and are anchored in the cell membrane via a C-terminaltransmembrane domain (TM helix) or a C-terminal GPI-anchor. TheIg_(v)-like domain is also referred to as N-terminal domain or N-domain.For example, human CEACAM1 comprises an N-domain followed by three (A1,B, A2) Igc₂-like domains. In one embodiment, the N-domain of humanCEACAM1 comprises, essentially consists of or consists of amino acidresidues 35 to 142 of human CEACAM1.

According to the present invention, the member of the CEACAM family ispreferably expressed on the surface of epithelial cells, endothelialcells and/or immune cells (in particular leukocytes, such as T cells, Bcells and neutrophils). In one embodiment, the member of the CEACAMfamily is expressed on the surface of epithelial cells (e.g., gastricepithelial cells), preferably at the apical side of epithelial cells.

According to the present invention, the member of the CEACAM family ispreferably selected from the group consisting of human CEACAM familymembers, non-human primate CEACAM family members and rat CEACAM familymembers. In one embodiment, the member of the CEACAM family is a memberof the human CEACAM family. In one embodiment, the member of the CEACAMfamily is not CEACAM 8. In one embodiment, the member of the CEACAMfamily is not CEACAM4, CEACAM7 and CEACAM8. In one embodiment, themember of the CEACAM family is selected from the group consisting ofCEACAM1, CEACAM3, CEACAM5 and CEACAM6. In one embodiment, the member ofthe CEACAM family is selected from the group consisting of CEACAM1,CEACAM5 and CEACAM6. In one embodiment, the member of the CEACAM familyis CEACAM1. The UniProt ID of human CEACAM1 is P13688. The UniProt ID ofhuman CEACAM3 is P40198. The UniProt ID of human CEACAM5 is P06731. TheUniProt ID of human CEACAM6 is P40199.

The terms “H. pylori HopQ” and “HopQ” are used interchangeably herein.HopQ is a member of a H. pylori-specific, paralogous family of outermembrane proteins. H. pylori hopQ (omp27; HP1177 in the H. pylorireference strain 26695) exhibits genetic diversity that represents twoallelic families, type I and type IL According to the present invention,the term “H. pylori HopQ” encompasses both type I and type II HopQproteins. In one embodiment, H. pylori HopQ is a type I HopQ protein ora type II HopQ protein. In one embodiment, the type I HopQ protein hasthe amino acid sequence of SEQ ID NO: 1 or SEQ ID NO: 3 or SEQ ID NO: 15or an amino acid sequence which is at least 70%, 75%, 80%, 85%, 90%,95%, 96%, 97%, 98% or 99% similar, preferably identical, to the aminoacid sequence of SEQ ID NO: 1 or SEQ ID NO: 3 or SEQ ID NO: 15. In oneembodiment, the type II HopQ protein has the amino acid sequence of SEQID NO: 5 or an amino acid sequence which is at least 70%, 75%, 80%, 85%,90%, 95%, 96%, 97%, 98% or 99% similar, preferably identical, to theamino acid sequence of SEQ ID NO: 5.

“Sequence similarity” indicates the percentage of amino acids thateither are identical or that represent conservative amino acidsubstitutions. “Sequence identity” between two amino acid sequencesindicates the percentage of amino acids that are identical between thesequences. The alignment for determining sequence similarity, preferablysequence identity, can be done with art known tools, preferably usingthe best sequence alignment, for example, using CLC main Workbench (CLCbio) or Align, using standard settings, preferably EMBOSS::needle,Matrix: Blosum62, Gap Open 10.0, Gap Extend 0.5.

In one embodiment, the inhibitor inhibits binding of H. pylori HopQ tothe member of the CEACAM family and/or HopQ-CEACAM-mediated signaling.

The term “HopQ-CEACAM-mediated signaling”, as used herein, refers toactivation of the CagA virulence pathway and/or phosphorylation of CagAand/or CagA translocation into cells (e.g., epithelial cells) and/orIL-8 induction and/or cell elongation. In one embodiment,HopQ-CEACAM-mediated signaling refers to CagA translocation into cells(e.g., epithelial cells), IL-8 induction and cell elongation. In oneembodiment, HopQ-CEACAM-mediated signaling refers to CagA translocationinto cells (e.g., epithelial cells).

In one embodiment, the inhibitor inhibits, e.g., competitively inhibits,binding of H. pylori HopQ to the member of the CEACAM family, preferablyto an extracellular domain of the member of the CEACAM family.

The term “extracellular domain”, as used herein, is meant to refer tothose parts of a protein that are not cytosolic/cytoplasmic or embeddedin the membrane, and includes parts located/exposed at the surface ofthe cell and/or in the periplasmic space. Such sequences/domains may beidentified by using standard bioinformatic tools and/or public databasesknown to a person skilled in the art. In one embodiment, theextracellular domain further lacks the N-terminal secretion sequence.

In connection with a member of the CEACAM family, the term“extracellular domain” may refer to the entire extracellular part ofsaid member, which, preferably, comprises the N-domain that, dependingon the specific CEACAM family member, may be followed by one or moreIgc₂-like domains. In one embodiment, the extracellular domain of theCEACAM family member comprises, essentially consists of or consists ofthe N-domain and 1, 2, 3, 4, 5 or 6 Ig_(C2)-like domain(s). In oneembodiment, the extracellular domain of the CEACAM family membercomprises, essentially consists of or consists of the N-domain. In oneembodiment, the extracellular domain is the N-domain. The term“fragment” when used in connection with the extracellular domain of theCEACAM family member may refer to the N-domain and/or one or moreIg_(C2)-like domain(s). The term “fragment” may also refer to fragmentsof the N-domain and/or one or more Ig_(C2)-like domain(s), providedthese fragments are able to interact with and/or bind to H. pylori HopQ(also referred to as HopQ-binding fragments).

In connection with H. pylori HopQ, the term “extracellular domain” mayrefer to the entire extracellular part of H. pylori HopQ, i.e., the fulllength protein lacking the C-terminal transmembrane domain. In oneembodiment, the extracellular domain further lacks the N-terminalbeta-strand and/or secretion sequence. In one embodiment, theextracellular domain corresponds to an amino acid sequence comprising,essentially consisting of or consisting of residues 37 to 463 of SEQ IDNO: 1. In one embodiment, the extracellular domain comprises,essentially consists of or consists of the insertion domain of H. pyloriHopQ. In one embodiment, the extracellular domain is the insertiondomain of H. pylori HopQ. In one embodiment, the extracellular domain ofH. pylori HopQ comprises, essentially consists of, consists of or isloop A, loop B, loop C and/or loop D, preferably loop A, loop B and/orloop C, of H. pylori HopQ. The term “fragment” when used in connectionwith the extracellular domain of H. pylori HopQ preferably refers tofragments that are able to interact with and/or bind to the CEACAMfamily member (also referred to as CEACAM-binding fragments).

The term “insertion domain”, as used herein, refers to the beta-hairpininsertion domain in H. pylori HopQ's extracellular 3+4 helix bundledomain, more particularly between helices H4 and H5, that is implicatedin CEACAM binding. The insertion domain is herein also referred to asHopQ-ID. In one embodiment, the insertion domain corresponds to an aminoacid sequence comprising, essentially consisting of or consisting ofresidues 210 to 238 of SEQ ID NO: 1.

The term “loop A”, as used herein, refers to a loop located betweenhelix H3 and strand S1 of H. pylori HopQ.

In one embodiment, loop A comprises, essentially consists of or consistsof the amino acid sequenceCGGYX_(a5)X_(a6)X_(a7)PX_(a9)EX_(a11)X_(a12)QK (SEQ ID NO: 17),

wherein

X_(a5) is an amino acid selected from the group consisting of T and Y oris deleted;

X_(a6) is an amino acid selected from the group consisting of K and N oris deleted;

X_(a7) is an amino acid selected from the group consisting of S, K, Nand T or is deleted;

X_(a9) is an amino acid selected from the group consisting of G, S, Q,R, T, I and V or is deleted;

X_(a11) is an amino acid selected from the group consisting of N and Gor is deleted; and

X_(a12) is an amino acid selected from the group consisting of N and Hor is deleted.

In one embodiment, loop A comprises, essentially consists of or consistsof the amino acid sequence of SEQ ID NO: 21. In one embodiment, loop Acorresponds to an amino acid sequence comprising, essentially consistingof or consisting of residues 123 to 136 of SEQ ID NO: 15.

The term “loop B”, as used herein, refers to a loop located betweenstrand S2 and helix H4 of H. pylori HopQ.

In one embodiment, loop B comprises, essentially consists of or consistsof the amino acid sequenceCGGX_(b4)X_(b5)X_(b6)X_(b7)X_(b8)GX_(b10)X_(b11)X_(b12)X_(b13)X_(b14)X_(b15)GX_(b17)X_(b18)X_(b19)LX_(b21)AX_(b23)KX_(b25)X_(b26)SLSI(SEQ ID NO: 18),

wherein

X_(b4) is an amino acid selected from the group consisting of S, G, N, Tand F or is deleted;

X_(b5) is an amino acid selected from the group consisting of T and I oris deleted;

X_(b6) is an amino acid selected from the group consisting of N, G and Kor is deleted;

X_(b7) is an amino acid selected from the group consisting of S and A oris deleted;

X_(b8) is an amino acid selected from the group consisting of N and D oris deleted;

X_(b10) is an amino acid selected from the group consisting of Q, K andR or is deleted;

X_(b11) is an amino acid selected from the group consisting of T, V andS or is deleted;

X_(b12) is an amino acid selected from the group consisting of H, Q andY or is deleted;

X_(b13) is an amino acid selected from the group consisting of S and Nor is deleted;

X_(b14) is an amino acid selected from the group consisting of S, P andN or is deleted;

X_(b15) is an amino acid selected from the group consisting of N and Sor is deleted;

X_(b17) is an amino acid selected from the group consisting of T and V;

X_(b18) is an amino acid selected from the group consisting of N and S;

X_(b19) is an amino acid selected from the group consisting of T, L andM or is deleted;

X_(b21) is an amino acid selected from the group consisting of K and Por is deleted;

X_(b23) is an amino acid selected from the group consisting of D, G andA or is deleted;

X_(b25) is an amino acid selected from the group consisting of N and Gor is deleted; and

X_(b26) is an amino acid selected from the group consisting of V and Sor is deleted.

In one embodiment, loop B comprises, essentially consists of or consistsof the amino acid sequence of SEQ ID NO: 22 or SEQ ID NO: 23. In oneembodiment, loop B corresponds to an amino acid sequence comprising,essentially consisting of or consisting of residues 152 to 180 of SEQ IDNO: 15.

The term “loop C”, as used herein, refers to a loop located betweenhelix H5 and helix H6 of H. pylori HopQ.

In one embodiment, loop C comprises, essentially consists of or consistsof the amino acid sequenceCPX_(c3)LIX_(c6)X_(c7)X_(c8)X_(c9)X_(c10)X_(c11)X_(c12)X_(c13)X_(c14)X_(c15)X_(c16)X_(c17)X_(c18)NX_(c20)PSWQX_(c25)X_(c26)X_(c27)X_(c28)X_(c29)KNX_(c32)C(SEQ ID NO: 19),

wherein

X_(c3) is an amino acid selected from the group consisting of M, I and Vor is deleted;

X_(c6) is an amino acid selected from the group consisting of A and G oris deleted;

X_(c7) is an amino acid selected from the group consisting of K and R oris deleted;

X_(c8) is an amino acid selected from the group consisting of S and T oris deleted;

X_(c9) is an amino acid selected from the group consisting of S and T oris deleted;

X_(c10) is an amino acid selected from the group consisting of S, N andG or is deleted;

X_(c11) is an amino acid selected from the group consisting of G, N, E,S and D or is deleted;

X_(c12) is an amino acid selected from the group consisting of S, G andN or is deleted;

X_(c13) is an amino acid selected from the group consisting of S, M, G,N and T or is deleted;

X_(c14) is an amino acid selected from the group consisting of G, A, T,S, N and M or is deleted;

X_(c15) is an amino acid selected from the group consisting of G, N, T,A and V or is deleted;

X_(c16) is an amino acid selected from the group consisting of A, N, Gand S or is deleted;

X_(c17) is an amino acid selected from the group consisting of T, N, A,G and S or is deleted;

X_(c18) is an amino acid selected from the group consisting of T and Aor is deleted;

X_(c20) is an amino acid selected from the group consisting of T and Aor is deleted;

X_(c25) is an amino acid selected from the group consisting of T and Ior is deleted;

X_(c26) is an amino acid selected from the group consisting of A, S, Tand N or is deleted;

X_(c27) is an amino acid selected from the group consisting of G and Sor is deleted;

X_(c28) is an amino acid selected from the group consisting of G and Nor is deleted;

X_(c29) is an amino acid selected from the group consisting of G, L andS or is deleted; and

X_(c32) is an amino acid selected from the group consisting of S and Aor is deleted.

In one embodiment, loop C comprises, essentially consists of or consistsof the amino acid sequence of SEQ ID NO: 24 or SEQ ID NO: 25. In oneembodiment, loop C corresponds to an amino acid sequence comprising,essentially consisting of or consisting of residues 258 to 290 of SEQ IDNO: 15.

The term “functional fragment” when used in connection with loops A, Band/or C preferably refers to fragments that are able to interact withand/or bind to the CEACAM family member (also referred to asCEACAM-binding fragments).

The term “loop D”, as used herein, refers to a loop located betweenhelix H7 and helix H8 of H. pylori HopQ.

In one embodiment, loop D comprises, essentially consists of or consistsof the amino acid sequenceSSX_(d3)X_(d4)LKX_(d7)YIX_(d10)KCDX_(d14)SX_(d16)X_(d17)SX_(d19)X_(d20)X_(d21)X_(d22)X_(d23)NMX_(d26)X_(d27)X_(d28)X_(d29)X_(d30)KX_(d32)X_(d33)X_(d34)WGX_(d37)GCAG(SEQ ID NO: 20),

wherein

X_(d3) is an amino acid selected from the group consisting of G and D oris deleted;

X_(d4) is an amino acid selected from the group consisting of H and Y oris deleted;

X_(d7) is an amino acid selected from the group consisting of D and N oris deleted;

X_(d10) is an amino acid selected from the group consisting of G and Ror is deleted;

X_(d14) is an amino acid selected from the group consisting of M, A andV or is deleted;

X_(d16) is an amino acid selected from the group consisting of A and Gor is deleted;

X_(d17) is an amino acid selected from the group consisting of I and Vor is deleted;

X_(d19) is an amino acid selected from the group consisting of S and Gor is deleted;

X_(d20) is any amino acid or is deleted;

X_(d21) is any amino acid or is deleted;

X_(d22) is any amino acid or is deleted;

X_(d23) is an amino acid selected from the group consisting of T, A andS or is deleted;

X_(d26) is an amino acid selected from the group consisting of T and Aor is deleted;

X_(d27) is an amino acid selected from the group consisting of M, P, Aand Q or is deleted;

X_(d28) is an amino acid selected from the group consisting of Q, R, Kand H or is deleted;

X_(d29) is an amino acid selected from the group consisting of S and Nor is deleted;

X_(d30) is an amino acid selected from the group consisting of Q and Mor is deleted;

X_(d32) is an amino acid selected from the group consisting of N and Sor is deleted;

X_(d33) is an amino acid selected from the group consisting of N and Tor is deleted;

X_(d34) is an amino acid selected from the group consisting of T, N andI or is deleted; and

X_(d37) is an amino acid selected from the group consisting of N and Kor is deleted.

In one embodiment, loop D comprises, essentially consists of or consistsof the amino acid sequence of SEQ ID NO: 26 or SEQ ID NO: 27. In oneembodiment, loop D corresponds to an amino acid sequence comprising,essentially consisting of or consisting of residues 371 to 407 of SEQ IDNO: 15.

In one embodiment, the inhibitor is selected from the group consistingof

(a) (poly-)peptide ligands or peptidomimetic ligands binding to H.pylori HopQ, preferably to an extracellular domain of H. pylori HopQ;

(b) (poly-)peptide ligands or peptidomimetic ligands binding to themember of the CEACAM family, preferably to an extracellular domain ofthe member of the CEACAM family, more preferably to the N-domain of themember of the CEACAM family;

(c) nucleic acid molecules encoding the (poly-)peptide ligands of (a)and (b);

(d) nucleic acid ligands binding to H. pylori HopQ, preferably to anextracellular domain of H. pylori HopQ;

(e) nucleic acid ligands binding to the member of the CEACAM family,preferably to an extracellular domain of the member of the CEACAMfamily, more preferably to the N-domain of the member of the CEACAMfamily;

(f) inhibitory nucleic acid molecules inhibiting the expression of themember of the CEACAM family or of H. pylori HopQ;

(g) small molecules binding to H. pylori HopQ, preferably to anextracellular domain of H. pylori HopQ; and

(h) small molecules binding to the member of the CEACAM family,preferably to an extracellular domain of the member of the CEACAMfamily, more preferably to the N-domain of the member of the CEACAMfamily.

The term “(poly-)peptide ligand”, as used herein, is meant to refer to aligand of the member of the CEACAM family or a ligand of H. pylori HopQ,which is a (poly-)peptide, wherein the term “(poly-)peptide” refers to amolecule which is either a peptide or a polypeptide.

The term “peptide” generally relates to substances which include atleast 2, at least 3, at least 4, at least 6, at least 8, at least 10, atleast 12 or at least 14 and preferably up to 8, 10, 12, 14, 16, 18, 20,25, 30, 50, or 100 consecutive amino acids which are connected togetherby peptide bonds. The terms “polypeptide” and “protein” relate to largepeptides, preferably peptides having more than 100 amino acids, but theterms “peptide”, “polypeptide” and “protein” are generally usedinterchangeably herein.

(Poly-)peptides according to the present invention are preferablyisolated. The term “isolated (poly-)peptide” means that the(poly-)peptide is separated from its natural environment. An isolated(poly-)peptide may be in an essentially purified and/or pure state. Theterm “essentially purified” or “essentially pure” means that the(poly-)peptide is essentially free of other substances, e.g., substanceswith which it is present and/or associated in nature or in vivo, such asother proteins, nucleic acids, lipids and carbohydrates. In someembodiments, (poly-)peptides according to the present invention are(chemically) synthesized.

According to the present invention, the (poly-)peptide ligands arepreferably selected from the group consisting of antibodies, antibodyderivatives, antibody mimetics, peptide aptamers and soluble fragmentsof the member of the CEACAM family or of H. pylori HopQ.

The term “antibody” (also referred to as immunoglobulin, Ig) refers to aglycoprotein comprising at least two heavy (H) chains and two light (L)chains inter-connected by disulfide bonds. Each heavy chain is comprisedof a heavy chain variable region (abbreviated herein as VH) and a heavychain constant region. Each light chain is comprised of a light chainvariable region (abbreviated herein as VL) and a light chain constantregion. The VH and VL regions can be further subdivided into regions ofhypervariability, termed complementarity determining regions (CDR),interspersed with regions that are more conserved, termed frameworkregions (FR). Each VH and VL is composed of three CDRs and four FRs,arranged from amino-terminus to carboxy-terminus in the following order:FR1, CDR1, FR2, CDR2, FR3, CDR3, FR4. The variable regions of the heavyand light chains contain a binding domain that interacts with anantigen. The constant regions of the antibodies may mediate the bindingof the immunoglobulin to host tissues or factors, including variouscells of the immune system (e.g., effector cells) and the firstcomponent (Clq) of the classical complement system.

The term “antibody derivative”, as used herein, refers to a moleculecomprising at least one antibody variable domain, but not having theoverall structure of an antibody such as IgA, IgD, IgE, IgG, IgM, IgY orIgW, although still being capable of binding a target molecule. Saidderivatives may be, but are not limited to functional (i.e. targetbinding, particularly specifically target binding) antibody fragments,such as Fab, Fab2, scFv, Fv, or parts thereof, or other derivatives orcombinations of the immunoglobulins such as nanobodies, diabodies,minibodies, camelid single domain antibodies, single domains or Fabfragments, domains of the heavy and light chains of the variable region(such as Fd, VL, including Vlambda and Vkappa, VH, VHH) as well asmini-domains consisting of two beta-strands of an immunoglobulin domainconnected by at least two structural loops. Preferably, the antibodyderivative is monovalent. More preferably, the derivative is a singlechain antibody, most preferably having the structure VL-peptidelinker-VH or VH-peptide linker-VL.

The term “antibody mimetic”, as used herein, refers to artificial(poly-)peptides that, like antibodies, can specifically bind antigens,but that are not structurally related to antibodies. They are usuallysignificantly smaller than antibodies with a molar mass of about 3 to 20kDa. Non-limiting examples of antibody mimetics are affibodies,affitins, affimers, alphabodies, affitins, anticalins, avimers, DARPins,fynomers, Kunits domain peptides, monobodies, Z domain of Protein A,Gamma B crystalline, ubiquitin, cystatin, Sac7D from Sulfolobusacidocaldarius, lipocalin, A domain of a membrane receptor, ankyrinrepeat motive, SH3 domain of Fyn, Kunits domain of protease inhibitors,the 10^(th) type III domain of fibronectin, 3- or 4-helix bundleproteins, an armadillo repeat domain, a leucine-rich repeat domain, aPDZ domain, a SUMO or SUMO-like domain, an immunoglobulin-like domain,phosphotyrosine-binding domain, pleckstrin homology domain, src homology2 domain or synthetic peptide ligands, e.g., from a (random) peptidelibrary. Synthetic peptide ligands have non-naturally occurring aminoacid sequences that function to bind a particular target molecule.

Peptide aptamers are proteins that are designed to interfere with otherprotein interactions. They usually consist of a variable peptide loopattached at both ends to a protein scaffold. The variable loop length istypically composed of ten to twenty amino acids, and the scaffold may beany protein which has good solubility and compacity properties, e.g.,thioredoxin-A. Also encompassed by the term “peptide aptamer”, as usedherein, are derivatives of peptide aptamers, such as affimer proteins.

The terms “part” or “fragment” are used interchangeably herein and referto a continuous element. For example, a part of a structure, such as anamino acid sequence or protein, refers to a continuous element of saidstructure. A part or fragment of a protein sequence preferably comprisesa sequence of at least 6, in particular at least 8, at least 12, atleast 15, at least 20, at least 30, at least 50, at least 100, at least150, at least 160, at least 170, at least 180, at least 190 or at least200 consecutive amino acids of the protein sequence. According to thepresent invention, a part or fragment of a protein sequence does,preferably, not comprise continuous with the part or fragment further N-and/or C-terminal amino acid sequences of the protein sequence.

The term “soluble”, as used in connection with fragments of CEACAMfamily members or H. pylori HopQ, refers to (poly-)peptides that arepredominantly soluble in an aqueous solution, such as water, PBS orcytosol (e.g., at pH 6-8). The term “predominantly soluble” means that amajority, e.g., >50% or >60% or >70% or >80% or >90%, of the(poly-)peptide molecules are in a soluble state in said aqueoussolution. In one embodiment, such soluble fragments lack a transmembranedomain or a GPI-anchor.

In one embodiment, a soluble fragment of the CEACAM family membercomprises, essentially consists of or consists of an extracellulardomain of the CEACAM family member or a HopQ-binding fragment thereof.In one embodiment, the soluble fragment comprises, essentially consistsof or consists of the N-domain or a HopQ-binding fragment thereof.

In one embodiment, a soluble fragment of H. pylori HopQ comprises,essentially consists of or consists of an extracellular domain of H.pylori HopQ or a CEACAM-binding fragment thereof. In one embodiment, thesoluble fragment comprises, essentially consists of or consists of theinsertion domain, loop A, loop B, loop C and/or loop D, preferably loopA, loop B and/or loop C, of H. pylori HopQ or a functional fragment ofany of the foregoing.

Also encompassed by the present invention are peptidomimetic variants ofthe soluble fragments of the member of the CEACAM family or of H. pyloriHopQ. Further encompassed are amino acid insertion variants, amino acidaddition variants, amino acid deletion variants and/or amino acidsubstitution variants as described further below. Such variants are,according to the invention, functional variants which inhibit theinteraction between H. pylori HopQ and of the member of the CEACAMfamily.

In one embodiment, the soluble fragment further comprises a detectablelabel or tag as described further below. In one embodiment, the solublefragment further comprises one or more modifications increasing thestability and/or preventing aggregation of the soluble fragment, asdescribed further below in connection with immunogenic fragments.

The term “peptidomimetic ligand”, as used herein, is meant to refer to aligand of the member of the CEACAM family or a ligand of H. pylori HopQ,which is a peptidomimetic.

The term “peptidomimetic”, as used herein, refers to a compound whichhas essentially the same general structure of a corresponding(poly-)peptide with modifications that increase its stability and/orbiological function. A peptidomimetic includes, for example, thosecompounds comprising the same amino acid sequence of a corresponding(poly-)peptide with an altered backbone between two or more of the aminoacids. Alternatively or additionally, the peptidomimetic can comprisesynthetic or non-naturally occurring amino acids in place ofnaturally-occurring amino acids. Exemplary peptidomimetics includepeptoids, beta-peptides and D-peptides.

The term “peptidomimetic variant”, as used herein, is meant to refer tothe peptidomimetic derivative of a given natural parent (poly-)peptide,e.g., of a soluble fragment of the member of the CEACAM family or of H.pylori HopQ.

The term “peptoid”, as used herein, refers to a peptidomimetic in whichthe sidechains of each amino acid is appended to the nitrogen atom ofthe amino acid as opposed to the alpha carbon. For example, peptoids canbe considered as N-substituted glycines which have repeating units ofthe general structure of NRCH₂CO and which have the same orsubstantially the same amino acid sequence as the correspondingpolypeptide.

Beta-peptides consist of beta amino acids, which have their amino groupbonded to the beta carbon rather than the alpha carbon as in the 20standard biological amino acids. Beta-peptides are stable againstproteolytic degradation in vitro and in vivo.

A D-peptide is a sequence of D-amino acids. Just as beta-peptides,D-peptides are less susceptible to be degraded in the stomach or insidecells by proteolysis.

A nucleic acid molecule may according to the invention be in the form ofa molecule, which is single-stranded or double-stranded and linear orcovalently closed to form a circle. In one embodiment, the nucleic acidmolecule is DNA or RNA or XNA.

In the context of the present invention, the term “DNA” relates to amolecule, which comprises deoxyribonucleotide residues and preferably isentirely or substantially composed of deoxyribonucleotide residues.“Deoxyribonucleotide” relates to a nucleotide, which lacks a hydroxylgroup at the 2′-position of a β-D-ribofuranosyl group. The term “DNA”comprises isolated DNA such as partially or completely purified DNA,essentially pure DNA, synthetic DNA, and recombinantly generated DNA andincludes modified DNA, which differs from naturally occurring DNA byaddition, deletion, substitution and/or alteration of one or morenucleotides. Such alterations can include addition of non-nucleotidematerial, such as to the end(s) of a DNA or internally, for example atone or more nucleotides of the DNA. Nucleotides in DNA molecules canalso comprise non-standard nucleotides, such as non-naturally occurringnucleotides or chemically synthesized nucleotides. These altered DNAscan be referred to as analogs or analogs of naturally occurring DNA.

In the context of the present invention, the term “RNA” relates to amolecule, which comprises ribonucleotide residues and preferably isentirely or substantially composed of ribonucleotide residues.“Ribonucleotide” relates to a nucleotide with a hydroxyl group at the2′-position of a β-D-ribofuranosyl group. The term “RNA” comprisesisolated RNA such as partially or completely purified RNA, essentiallypure RNA, synthetic RNA, and recombinantly generated RNA and includesmodified RNA, which differs from naturally occurring RNA by addition,deletion, substitution and/or alteration of one or more nucleotides.Such alterations can include addition of non-nucleotide material, suchas to the end(s) of a RNA or internally, for example at one or morenucleotides of the RNA. Nucleotides in RNA molecules can also comprisenon-standard nucleotides, such as non-naturally occurring nucleotides orchemically synthesized nucleotides or deoxynucleotides. These alteredRNAs can be referred to as analogs or analogs of naturally occurringRNA. According to the invention, “RNA” refers to single-stranded RNA ordouble stranded RNA. In one embodiment, the RNA is mRNA. In oneembodiment, the RNA is in vitro transcribed RNA (IVT RNA) or syntheticRNA.

A xeno-nucleic acid (XNA) is a synthetic DNA/RNA analogue containingnon-natural components such as alternative nucleobases, sugars, or aconnecting backbone with a different chemical structure.

The term “nucleic acid ligand”, as used herein, is meant to refer to aligand of the member of the CEACAM family or a ligand of H. pylori HopQ,which is a nucleic acid molecule, e.g., a nucleic acid aptamer.

Nucleic acid aptamers, i.e., RNA aptamers, DNA aptamers and XNAaptamers, are a class of small nucleic acid ligands that are composed ofRNA or single-stranded DNA or XNA oligonucleotides and have highspecificity and affinity for their targets. Similar to antibodies,aptamers interact with their targets by recognizing a specificthree-dimensional structure.

The term “inhibitory nucleic acid molecule”, as used herein, refers to anucleic acid molecule which inhibits expression of a target molecule,e.g., a member of the CEACAM family or H. pylori HopQ. Exemplaryinhibitory nucleic acid molecules include small interfering RNA (siRNA),small/short hairpin RNA (shRNA), microRNA (miRNA) and antisense DNA orRNA molecules, all of which are well-known to a person skilled in theart.

The term “small molecule”, as used herein, refers to a low molecularweight (e.g., <900 Da or <500 Da) organic compound.

The term “binding” may in context of the present invention, e.g., inconnection with the (poly-)peptide ligands, nucleic acid ligands orsmall molecules as defined herein, refer to specific binding. The terms“specific binding” or “specifically binding”, as used herein, mean thata binding to a target, such as an epitope for which a binding agent,such as a (poly-)peptide ligand (e.g., an antibody), is specific, isstronger by comparison with the binding to another target. A “strongerbinding” can be characterized for example by a lower dissociationconstant (K_(D)). In one embodiment, a binding agent is specific for apredetermined target if it is capable of binding to said predeterminedtarget while it is not capable of binding to other targets. In oneembodiment, a binding agent that “specifically binds” a target has anK_(D) value of less than 10⁻⁵ M (e.g., 10⁻⁶, 10⁻⁷, 10⁻⁸, 10⁻⁹, 10⁻¹⁰,10⁻¹¹, and 10⁻¹² or less) for that target. The K_(D) value of a givenbinding agent is influenced both by the on and off-rate of the bindingagent and varies with the temperature. It is preferred in the context ofthe present invention that the K_(D) value is below above indicatedvalues at room temperature. The binding conditions are preferablyphysiological conditions. The skilled person is aware of various assaysto determine the K_(D) value. A preferred assay system is a competitionassay.

In one embodiment, the (poly-)peptide ligands or peptidomimetic ligandsor nucleic acid ligands or small molecules binding to H. pylori HopQbind to an epitope of H. pylori HopQ comprising at least 1, 2, 3, 4, 5,6, 7 or 8 amino acid residues comprised in the insertion domain, loop A,loop B, loop C and/or loop D, preferably loop A, loop B and/or loop C,of H. pylori HopQ.

In one embodiment, the inhibitor is comprised in a pharmaceuticalcomposition. Accordingly, the present invention also provides apharmaceutical composition comprising an inhibitor of the interactionbetween H. pylori HopQ and a member of the CEACAM family as definedherein.

The present invention further provides an in vitro method foridentifying a drug candidate for preventing or treating a disease ordisorder caused by or associated with H. pylori, the method comprising

(a) contacting (i) a CEACAM protein or a functional fragment thereofwith (ii) a H. pylori HopQ protein or a functional fragment thereof and(iii) a test compound, and

(b) determining whether the test compound inhibits the interactionbetween the CEACAM protein or the functional fragment thereof and the H.pylori HopQ protein or the functional fragment thereof, wherein a testcompound inhibiting the interaction between the CEACAM protein or thefunctional fragment thereof and the H. pylori HopQ protein or thefunctional fragment thereof is identified as a drug candidate forpreventing or treating a disease or disorder caused by or associatedwith H. pylori.

In one embodiment, step (b) comprises determining whether the testcompound inhibits binding of the H. pylori HopQ protein or thefunctional fragment thereof to the CEACAM protein or the functionalfragment thereof, wherein, preferably, the functional fragment of the H.pylori HopQ protein comprises an extracellular domain or a fragmentthereof, and/or the functional fragment of the CEACAM protein comprisesan extracellular domain or a fragment thereof, preferably the N-domain,and/or determining whether the test compound inhibitsHopQ-CEACAM-mediated signaling.

In one embodiment, the test compound is selected from the groupconsisting of (poly-)peptides, peptidomimetics, nucleic acid moleculesand small molecules.

The present invention further provides the use of a CEACAM protein or afunctional fragment thereof being able to interact with H. pylori HopQfor studying H. pylori infection or identifying a drug candidate forpreventing or treating a disease or disorder caused by or associatedwith H. pylori.

The term “functional fragment”, as used herein in connection with aCEACAM protein, may, for example, refer to an extracellular domain ofthe CEACAM protein or a fragment thereof.

The present invention further provides the use of a cell heterologouslyexpressing a CEACAM protein or a functional fragment thereof being ableto interact with H. pylori HopQ for studying H. pylori infection oridentifying a drug candidate for preventing or treating a disease ordisorder caused by or associated with H. pylori.

Such cell (also referred to as host cell) may either be a prokaryoticcell (e.g., a bacterial cell) or a eukaryotic cell (e.g., a fungal,plant or animal cell). In one embodiment, the cell is a mammalian cell,e.g., a CHO cell or HEK293 cell. Preferably, the cell is an isolatedcell.

The present invention further provides the use of a non-human transgenicanimal heterologously expressing a CEACAM protein or a functionalfragment thereof being able to interact with H. pylori HopQ for studyingH. pylori infection or identifying a drug candidate for preventing ortreating a disease or disorder caused by or associated with H. pylori.

The term “non-human transgenic animal”, as used herein, relates, inparticular, to non-human mammals, e.g., a rodent, a rabbit, a cow, asheep, a horse, a dog, a cat, a lama, a pig, or a non-human primate(e.g., a monkey). The rodent may be a mouse, rat, hamster, guinea pig,or chinchilla. In one embodiment, the non-human transgenic animal is arat.

The present invention further provides an inhibitor of the interactionbetween H. pylori HopQ and a member of the carcinoembryonicantigen-related cell adhesion molecule (CEACAM) family, wherein theinhibitor is selected from the group consisting of

(a) (poly-)peptide ligands or peptidomimetic ligands binding to anextracellular domain of H. pylori HopQ;

(b) (poly-)peptide ligands or peptidomimetic ligands binding to theN-domain of the member of the CEACAM family;

(c) nucleic acid molecules encoding the (poly-)peptide ligands of (a)and (b);

(d) nucleic acid ligands binding to an extracellular domain of H. pyloriHopQ;

(e) nucleic acid ligands binding to the N-domain of the member of theCEACAM family;

(f) inhibitory nucleic acid molecules inhibiting the expression of themember of the CEACAM family or of H. pylori HopQ;

(g) small molecules binding to an extracellular domain of H. pyloriHopQ; and

(h) small molecules binding to the N-domain of the member of the CEACAMfamily.

In one embodiment, the extracellular domain of H. pylori HopQ is theinsertion domain of H. pylori HopQ.

In one embodiment, the extracellular domain of H. pylori HopQ is loop A,loop B, loop C or loop D of H. pylori HopQ.

In one embodiment, the (poly-)peptide ligands or peptidomimetic ligandsare selected from soluble fragments of the member of the CEACAM familyor of H. pylori HopQ and peptidomimetic variants thereof, respectively.

In one embodiment, the soluble fragments of H. pylori HopQ comprise theinsertion domain of H. pylori HopQ or a functional fragment thereof.

In one embodiment, the soluble fragments of H. pylori HopQ comprise loopA, loop B, loop C or loop D of H. pylori HopQ or a functional fragmentof any of the foregoing.

The present invention also provides an immunogenic compositioncomprising

(a) at least one, e.g., one, two, three, four or five or more, isolated(poly-)peptide comprising (i) the amino acid sequence of H. pylori HopQ;or (ii) an immunogenic variant thereof; or (iii) an immunogenic fragmentof (i) or (ii); or

(b) at least one, e.g., one, two, three, four or five or more, nucleicacid molecule encoding an isolated (poly-)peptide according to item (a).

The term “immunogenic”, as used herein, is meant to refer to the abilityto provoke an immune response, i.e., to induce a humoral and/orcell-mediated immune response, in a subject. A “humoral immune response”is mediated by macromolecules found in extracellular body fluids, suchas secreted antibodies, complement proteins and certain antimicrobialpeptides. A “cell-mediated immune response” involves the activation ofphagocytes, antigen-specific T-lymphocytes and the release of variouscytokines in response to an antigen. In one embodiment, the immuneresponse is mediated by antibodies (=antibody response). The terms“immunogenic fragment” and “immunogenic variant”, as used herein,preferably refer to fragments and variants, which are able to elicit animmune response that is specific to the (poly-)peptide the fragments andvariants are derived from.

In one embodiment, the amino acid sequence of H. pylori HopQ is theamino acid sequence of SEQ ID NO: 1 or SEQ ID NO: 3 or SEQ ID NO: 5 orSEQ ID NO: 15 or an amino acid sequence which is at least 70%, 75%, 80%,85%, 90%, 95%, 96%, 97%, 98% or 99% similar, preferably identical, tothe amino acid sequence of SEQ ID NO: 1 or SEQ ID NO: 3 or SEQ ID NO: 5or SEQ ID NO: 15.

In one embodiment, the immunogenic fragment comprises, essentiallyconsists of or consists of an extracellular domain of H. pylori HopQ. Inone embodiment, the immunogenic fragment comprises the insertion domain,loop A, loop B, loop C and/or loop D of H. pylori HopQ. In oneembodiment, the immunogenic fragment lacks the N-terminal beta-strandand/or the N-terminal secretion sequence (=signal peptide) and/or theC-terminal transmembrane (TM) domain. In one embodiment, the immunogenicfragment lacks the N-terminal beta-strand and the N-terminal secretionsequence and the C-terminal TM domain. In one embodiment, theimmunogenic fragment comprises, essentially consists of or consists ofresidues 37 to 463 of SEQ ID NO: 1.

In one embodiment, the extracellular domain of H. pylori HopQ is theinsertion domain of H. pylori HopQ or a functional fragment thereof.

In one embodiment, the extracellular domain of H. pylori HopQ is loop A,loop B, loop C or loop D of H. pylori HopQ or a functional fragment ofany of the foregoing.

The term “immunogenic variant” according to the invention refers, inparticular, to immunogenic mutants, splice variants, conformationvariants, isoforms, allelic variants, species variants and homologues,in particular those, which occur naturally. An allelic variant relatesto an alteration in the normal sequence of a gene, the significance ofwhich is often unclear. Complete gene sequencing often identifiesnumerous allelic variants for a given gene. A homologue is a nucleicacid or amino acid sequence with a different species (or strain) oforigin from that of a given nucleic acid or amino acid sequence. Theterm “variant” shall encompass any posttranslationally modified variantsand conformation variants.

For the purposes of the present invention, “immunogenic variants” of anamino acid sequence comprise immunogenic amino acid insertion variants,amino acid addition variants, amino acid deletion variants and/or aminoacid substitution variants. Amino acid deletion variants that comprisethe deletion at the N-terminal and/or C-terminal end of the protein arealso called N-terminal and/or C-terminal truncation variants.

Amino acid insertion variants comprise insertions of single or two ormore amino acids in a particular amino acid sequence. In the case ofamino acid sequence variants having an insertion, one or more amino acidresidues are inserted into a particular site in an amino acid sequence,although random insertion with appropriate screening of the resultingproduct is also possible.

Amino acid addition variants comprise N- and/or C-terminal fusions ofone or more amino acids, such as 1, 2, 3, 5, 10, 20, 30, 50, or moreamino acids.

Amino acid deletion variants are characterized by the removal of one ormore amino acids from the sequence, such as by removal of 1, 2, 3, 5,10, 20, 30, 50, or more amino acids. The deletions may be in anyposition of the protein, for example at the N- and/or C-terminus.

Amino acid substitution variants are characterized by at least oneresidue in the sequence being removed and another residue being insertedin its place. In one embodiment, the amino acid substitution variantcomprises the substitution of up to 10, 9, 8, 7, 6, 5, 4, 3 or 2 aminoacids. Preference is given to modifications being in positions in theamino acid sequence which are not conserved between homologous proteinsor peptides and/or to replacing amino acids with other ones havingsimilar properties. Preferably, amino acid substitutions in proteinvariants are conservative amino acid substitutions. A conservative aminoacid substitution involves substitution of an amino acid with anotherone of the same family of amino acids, i.e., amino acids which arerelated in their side chains (e.g., in terms of the electrical chargeand/or size). Naturally occurring amino acids are generally divided intofour families: acidic (aspartate, glutamate), basic (lysine, arginine,histidine), non-polar (alanine, valine, leucine, isoleucine, proline,phenylalanine, methionine, tryptophan), and uncharged polar (glycine,asparagine, glutamine, cysteine, serine, threonine, tyrosine) aminoacids. Phenylalanine, tryptophan, and tyrosine are sometimes classifiedjointly as aromatic amino acids. However, it is also possible to replaceamino acids with other ones having different properties, e.g.,substituting one or more (surface-exposed) hydrophobic amino acids withone or more hydrophilic amino acids in order to reduce or inhibitaggregation of the isolated (poly-)peptides, wherein, preferably, otherproperties of these (poly-)peptides, e.g., their immunogenicity orbinding properties, are not compromised by such amino acidsubstitutions.

According to the present invention, the degree of similarity, preferablyidentity, between a given reference amino acid sequence and an aminoacid sequence which is a variant of said given amino acid sequence willpreferably be at least about 60%, 65%, 70%, 75%, 80%, 81%, 82%, 83%,84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%,98%, or 99%. The degree of similarity or identity is given preferablyfor an amino acid region which is at least about 10%, at least about20%, at least about 30%, at least about 40%, at least about 50%, atleast about 60%, at least about 70%, at least about 80%, at least about90% or about 100% of the entire length of the reference amino acidsequence. For example, if the reference amino acid sequence consists of200 amino acids, the degree of similarity or identity is givenpreferably for at least about 20, at least about 40, at least about 60,at least about 80, at least about 100, at least about 120, at leastabout 140, at least about 160, at least about 180, or about 200 aminoacids, preferably continuous amino acids. In preferred embodiments, thedegree/percentage of similarity or identity is given for the entirelength of the reference amino acid sequence.

In one embodiment, the immunogenic variant is an equivalent protein fromanother H. pylori strain. In one embodiment, the equivalent protein is ahomologue, preferably an orthologue. An “orthologue” is a homologousgene/protein that is related through speciation from a single ancestralgene/protein, not through gene duplication.

In one embodiment, the immunogenic variant comprises an amino acidsequence which is at least 60%, at least 70%, at least 80%, at least90%, at least 95% or at least 97% (e.g., 97% or 98% or 99%) identical toan amino acid sequence selected from the group consisting of SEQ ID NO:1, residues 37 to 463 of SEQ ID NO: 1, SEQ ID NO: 3, SEQ ID NO: 15 andSEQ ID NO: 5.

In one embodiment, the isolated (poly-)peptide is a recombinant(poly-)peptide.

The term “recombinant (poly-)peptide”, as used herein, is meant to referto a (poly-)peptide resulting from the expression of recombinant nucleicacid molecules (e.g., DNA) within living cells, e.g. by means ofparticular expression vectors. Recombinant nucleic acid molecules arenucleic acid molecules formed by laboratory methods of geneticrecombination (e.g., molecular cloning).

In one embodiment, the isolated (poly-)peptide is produced in a hostcell, preferably a prokaryotic host cell, such as E. coli.

In one embodiment, the isolated (poly-)peptide described herein furthercomprises a detectable label or tag. The term “detectable label or tag”,as used herein, refers to detectable labels or tags allowing thedetection and/or isolation and/or immobilization of the isolated(poly-)peptides described herein, and is meant to include anylabels/tags known in the art for these purposes. Particularly preferredare affinity tags, such as chitin binding protein (CBP), maltose bindingprotein (MBP), glutathione-S-transferase (GST), poly(His) (e.g., 6× Hisor His6), Strep-tag®, Strep-tag II® and Twin-Strep-tag®; solubilizationtags, such as thioredoxin (TRX), poly(NANP) and SUMO; chromatographytags, such as a FLAG-tag; epitope tags, such as V5-tag, myc-tag andHA-tag; fluorescent labels or tags (i.e., fluorochromes/-phores), suchas fluorescent proteins (e.g., GFP, YFP, RFP etc.) and fluorescent dyes(e.g., FITC, TRITC, coumarin and cyanine); luminescent labels or tags,such as luciferase; and (other) enzymatic labels (e.g., peroxidase,alkaline phosphatase, beta-galactosidase, urease or glucose oxidase).Also included are combinations of any of the foregoing labels or tags.

The amino acid sequence of a (poly)peptidic label or tag may beintroduced at any position within the amino acid sequence of theisolated (poly-)peptides described herein. For example, it may be addedto their N- and/or C-terminus and/or to an amino acid side chain, e.g.,by EDC-NHS coupling to lysines. The same applies to non-peptidic labelsor tags.

In one embodiment, the isolated (poly-)peptide is a fusion protein.

The term “fusion protein” refers to proteins created by joining two ormore distinct (poly-)peptides or proteins, preferably head-to-tail(i.e., N-terminus to C-terminus or vice versa), resulting in a singleprotein with functional properties derived from each of the originalproteins.

The present invention also provides a fusion protein as defined herein.

The isolated (poly-)peptide according to the present invention mayfurther comprise one or more modifications increasing the stabilityand/or preventing aggregation of the isolated (poly-)peptide. The term“stability” of the isolated (poly-)peptide relates, in particular, toits “half-life”, e.g., in vivo. “Half-life” relates to the period oftime which is needed to eliminate half of the activity, amount, ornumber of molecules. Prevention of aggregation will also increase thestorage stability of the isolated (poly-)peptide.

The isolated (poly-)peptide may, for example, be fused or conjugated toa half-life extension module. Such modules are known to a person skilledin the art and include, for example, albumin, an albumin-binding domain,an Fc region/domain of an immunoglobulins, an immunoglobulin-bindingdomain, an FcRn-binding motif, and a polymer. Particularly preferredpolymers include polyethylene glycol (PEG), hydroxyethyl starch (HES),hyaluronic acid, polysialic acid and PEG-mimetic peptide sequences.Modifications preventing aggregation of the isolated (poly-)peptides arealso known to the skilled person and include, for example, thesubstitution of one or more hydrophobic amino acids, preferablysurface-exposed hydrophobic amino acids, with one or more hydrophilicamino acids. In one embodiment, the isolated (poly-)peptide or theimmunogenic variant thereof or the immunogenic fragment of any of theforegoing, comprises the substitution of up to 10, 9, 8, 7, 6, 5, 4, 3or 2, preferably 5, 4, 3 or 2, hydrophobic amino acids, preferablysurface-exposed hydrophobic amino acids, with hydrophilic amino acids.Preferably, other properties of the isolated (poly-)peptide, e.g., itsimmunogenicity, are not compromised by such substitution.

The isolated (poly-)peptide according to the present invention may alsobe fused or conjugated to a carrier material, such as Keyhole LimpetHemocyanin (KLH), BSA, ovalbumin etc., in order to present therespective antigen to the immune system of the subject in a way thatallows or promotes the eliciting of an immune response and, inparticular, high titer antibodies.

The term “fused to”, as used herein, refers, in particular, to geneticfusion, e.g., by recombinant DNA technology.

The term “conjugated to”, as used herein, refers, in particular, tochemical and/or enzymatic conjugation resulting in a stable covalentlink.

The isolated (poly-)peptide according to the present invention mayfurther comprise an amino acid sequence allowing the targeted deliveryof the isolated (poly-)peptide to a given cell, tissue or organ,preferably an amino acid sequence that targets the isolated(poly-)peptide to a particular cell type, e.g., dendritic cells.Suitable amino acid sequences are described, e.g., in Sioud et al., 2013and Apostolopoulos et al., 2013, and include, for example a peptide withthe amino acid sequence NWYLPWLGTNDW (SEQ ID NO: 7).

In one embodiment, the nucleic acid molecule is DNA or RNA.

Also encompassed by the present invention are nucleic acid molecules,which hybridize under stringent hybridization conditions to a nucleicacid molecule according to above item (b).

“Stringent hybridization conditions”, as defined herein, involvehybridizing at 68° C. in 5×SSC/5×Denhardt's solution/1.0% SDS, andwashing in 0.2×SSC/0.1% SDS at room temperature, or involve anart-recognized equivalent thereof (e.g., conditions in which ahybridization is carried out at 60° C. in 2.5×SSC buffer, followed byseveral washing steps at 37° C. in a low buffer concentration, andremains stable). The parameters of salt concentration and temperaturecan be varied to achieve the optimal level of identity between theoligonucleotides and the target nucleic acid. Guidance regarding suchconditions is available in the art, for example, by Molecular Cloning: ALaboratory Manual, 3^(rd) Edition, J. Sambrook et al. eds., Cold SpringHarbor Laboratory Press, Cold Spring Harbor 2000, and Ausubel et al.(eds.), 1995, Current Protocols in Molecular Biology, (John Wiley andSons, N.Y.) at Unit 2.10.

In one embodiment, the nucleic acid molecule is codon-optimized, e.g.,for expression in bacteria other than H. pylori, such as E. coli, or forexpression in eukaryotic cells, such as mammalian cells (e.g., CHOcells, BHK cells, COS cells and HEK293 cells) or insect cells (e.g., SF9cells, SF21 cells and High Five™ cells).

In one embodiment, the nucleic acid molecule is contained/comprised in avector.

The term “vector”, as used herein, includes any vector known to theskilled person, including plasmid vectors, cosmid vectors, phagevectors, such as lambda phage, viral vectors, such as adenoviral, AAV orbaculoviral vectors, or artificial chromosome vectors such as bacterialartificial chromosomes (BAC), yeast artificial chromosomes (YAC), or P1artificial chromosomes (PAC). Said vectors include expression as well ascloning vectors. Expression vectors comprise plasmids as well as viralvectors and generally contain a desired coding sequence and appropriateDNA sequences necessary for the expression of the operably linked codingsequence in a particular host organism (e.g., bacteria, yeast, plant,insect, or mammal) or in in vitro expression systems. Cloning vectorsare generally used to engineer and amplify a certain desired DNAfragment and may lack functional sequences needed for expression of thedesired DNA fragments.

In one embodiment, the immunogenic composition further comprises atleast one additional antigen from H. pylori.

The term “additional antigen from H. pylori”, as used herein, preferablyrefers to an antigen which is different from the agents, i.e. theisolated (poly-)peptides and nucleic acid molecules, in accordance withabove items (a) and (b).

In a preferred embodiment, the additional antigen is selected from thegroup consisting of outer membrane proteins and virulence factorproteins of H. pylori, immunogenic fragments thereof and nucleic acidmolecules encoding these proteins or fragments.

The term “outer membrane protein” refers to proteins that are associatedwith the outer membrane of H. pylori, which includes integral membraneproteins as well as lipoproteins that are anchored to the membrane bymeans of N-terminally attached lipids. Their structure and function isfurther described, e.g., in Koebnik et al., 2000. Particularly preferredouter membrane proteins of H. pylori for use in accordance with thepresent invention are selected from the group consisting of BabA, HpaA,Omp18, Omp22 and SabA.

The term “virulence factor protein”, as used herein, refers to proteins,e.g., functional proteins, such as enzymes, that contribute to thepathogenicity of H. pylori (see, for example, Kalali et al., 2014). Aparticularly preferred virulence factor protein in accordance with thepresent invention is gamma-glutamyltranspeptidase (gGT) of H. pylori(also referred to as HPGGT or HPG). Suitable HPG proteins are, forexample, those described in WO 2008/046650 A1 and include anenzymatically inactivated form of HPG (S451/452A), optionally lackingthe N-terminal secretion sequence.

Additional antigens that may be part of the immunogenic composition inaccordance with the present invention are also those described in US2007/0042448 A1 or WO 2004/094467 A2.

In one embodiment, the immunogenic composition further comprises atleast one adjuvant.

The term “adjuvant” refers to a substance which enhances the immuneresponse to an antigen, e.g., to an agent in accordance with above items(a) and (b) or an additional antigen from H. pylori as defined herein,for example by providing a general stimulation of the immune system.Suitable adjuvants are known to a person skilled in the art and includetoxin-based adjuvants, TLR ligand-based adjuvants, nucleicacid/vector-based adjuvants, protein-based adjuvants, polymer-basedadjuvants, mucosal adjuvants, ISCOM matrices and combinations of any ofthe foregoing. Particular adjuvants include, but are not limited to,polycationic polymers/peptides, immunostimulatory deoxynucleotides(ODNs), synthetic KLK peptides, neuroactive compounds (e.g., humangrowth hormone), alumn, Freund's complete or incomplete adjuvants,cholera toxin (CT), CTA T-DD, heat-labile enterotoxin (LT), mutants ofCT or LT, poly-IC, dendritic cell (DC) binding peptides and C3d fusionprotein. In one embodiment, the TLR ligand-based adjuvant is a TLRSligand, e.g., from the group of bacterial flagellins, such as thosedescribed in WO 2010/050903 A1, Mori et al., 2012 and Song et al., 2015.In one embodiment, the adjuvant is selected from the group consisting ofcholera toxin (CT), CTA T-DD and heat-labile enterotoxin (LT).

In one embodiment, the immunogenic composition is a vaccine or iscomprised in a vaccine.

The term “vaccine” refers to a preparation that confers or improvesimmunity to a particular disease. A vaccine in accordance with thepresent invention confers or improves immunity to a disease or disordercaused by or associated with H. pylori, in particular the specificdiseases mentioned herein.

In one embodiment, the immunogenic composition of the present inventionelicits an immune response comprising the secretion of antibodies,wherein, preferably, the antibodies inhibit the interaction between H.pylori HopQ and a member of the carcinoembryonic antigen-related celladhesion molecule (CEACAM) family as defined herein. In one embodiment,the antibodies inhibit binding of H. pylori HopQ to the member of theCEACAM family and/or HopQ-CEACAM-mediated signaling. In one embodiment,the antibodies bind to an extracellular domain of H. pylori HopQ or afragment thereof, e.g., the insertion domain, loop A, loop B, loop Cand/or loop D of H. pylori HopQ. In one embodiment, the antibodies bindto an epitope of H. pylori HopQ comprising at least 1, 2, 3, 4, 5, 6, 7or 8 amino acid residues comprised in the insertion domain, loop A, loopB, loop C and/or loop D, preferably loop A, loop B and/or loop C, of H.pylori HopQ.

According to the invention, an immunogenic/pharmaceutical compositioncontains an effective amount of the active agents, e.g., the(poly-)peptides or peptidomimetics or nucleic acid molecules or smallmolecules described herein, to generate the desired reaction or thedesired effect.

An immunogenic/pharmaceutical composition in accordance with the presentinvention is preferably sterile. Immunogenic/pharmaceutical compositionscan be provided in a uniform dosage form and may be prepared in a mannerknown per se. An immunogenic/pharmaceutical composition in accordancewith the present invention may, e.g., be in the form of a solution orsuspension.

The immunogenic/pharmaceutical composition may further comprise one ormore carriers and/or excipients, all of which are preferablypharmaceutically acceptable. The term “pharmaceutically acceptable”, asused herein, refers to the non-toxicity of a material, which,preferably, does not interact with the action of the active agent of theimmunogenic/pharmaceutical composition. In particular, “pharmaceuticallyacceptable” means approved by a regulatory agency of the Federal or astate government or listed in the U.S. Pharmacopoeia, EuropeanPharmacopoeia or other generally recognized pharmacopeia for use inanimals, and more particularly in humans.

The term “carrier” refers to an organic or inorganic component, of anatural or synthetic nature, in which the active component is combinedin order to facilitate, enhance or enable application. According to theinvention, the term “carrier” also includes one or more compatible solidor liquid fillers, diluents or encapsulating substances, which aresuitable for administration to a subject. Possible carrier substances(e.g., diluents) are, for example, sterile water, Ringer's solution,Lactated Ringer's solution, physiological saline, bacteriostatic saline(e.g., saline containing 0.9% benzyl alcohol), phosphate-buffered saline(PBS), Hank's solution, fixed oils, polyalkylene glycols, hydrogenatednaphthalenes and biocompatible lactide polymers, lactide/glycolidecopolymers or polyoxyethylene/polyoxy-propylene copolymers. In oneembodiment, the carrier is PBS. The resulting solutions or suspensionsare preferably isotonic to the blood of the recipient. Suitable carriersand their formulations are described in greater detail in Remington'sPharmaceutical Sciences, 17^(th) ed., 1985, Mack Publishing Co.

The term “excipient”, as used herein, is intended to include allsubstances which may be present in a pharmaceutical composition andwhich are not active ingredients, such as salts, binders (e.g., lactose,dextrose, sucrose, trehalose, sorbitol, mannitol), lubricants,thickeners, surface active agents, preservatives, emulsifiers, buffersubstances, stabilizing agents, flavouring agents or colorants.

Salts, which are not pharmaceutically acceptable, may be used forpreparing pharmaceutically acceptable salts and are included in theinvention. Pharmaceutically acceptable salts of this kind comprise in anon-limiting way those prepared from the following acids: hydrochloric,hydrobromic, sulfuric, nitric, phosphoric, maleic, acetic, salicylic,citric, formic, malonic, succinic acids, and the like. Pharmaceuticallyacceptable salts may also be prepared as alkali metal salts or alkalineearth metal salts, such as sodium salts, potassium salts or calciumsalts. Salts may be added to adjust the ionic strength or tonicity.

Suitable preservatives for use in a pharmaceutical composition includeantioxidants, citric acid, sodium citrate, benzalkonium chloride,chlorobutanol, cysteine, methionine, parabens and thimerosal.

Suitable buffer substances for use in a pharmaceutical compositioninclude acetic acid in a salt, citric acid in a salt, boric acid in asalt and phosphoric acid in a salt. Other suitable buffer substancesinclude arginine-hydrochloride and arginine-phosphate.

Suitable stabilizing agents include glycerol, ascorbate and histidine.

The immunogenic compositions according to the present invention may alsobe formulated as described in U.S. Pat. No. 6,838,089 B1 and U.S. Pat.No. 6,372,260 B1.

The immunogenic/pharmaceutical composition in accordance with thepresent invention may also be formulated as a stable lyophilized productthat is reconstituted with an appropriate diluent, which, optionally,comprises one or more excipients as described above.

The present invention also provides an immunogenic composition asdefined herein for use as a medicament.

The present invention also provides an immunogenic composition asdefined herein for use in a method of preventing or treating a diseaseor disorder caused by or associated with H. pylori.

The present invention further provides the use of an immunogeniccomposition as defined herein in the preparation of a medicament forpreventing or treating a disease or disorder caused by or associatedwith H. pylori.

The present invention also provides a method of preventing or treating adisease or disorder caused by or associated with H. pylori in a subject,said method comprising administering the immunogenic composition asdefined herein to the subject.

The present invention further provides a CEACAM protein or a functionalfragment thereof being able to interact with H. pylori HopQ for use in amethod of preventing or treating a disease or disorder caused by orassociated with H. pylori, wherein the CEACAM protein or functionalfragment thereof is attached to a solid support, preferably anon-cellular solid support.

The present invention further provides the use of a CEACAM protein or afunctional fragment thereof being able to interact with H. pylori HopQin the preparation of a medicament for preventing or treating a diseaseor disorder caused by or associated with H. pylori, wherein the CEACAMprotein or functional fragment thereof is attached to a solid support,preferably a non-cellular solid support.

The present invention also provides a method of preventing or treating adisease or disorder caused by or associated with H. pylori in a subject,said method comprising administering a CEACAM protein or a functionalfragment thereof being able to interact with H. pylori HopQ to thesubject, wherein the CEACAM protein or functional fragment thereof isattached to a solid support, preferably a non-cellular solid support.

The term “solid support”, as used herein, refers to any solid supportable to bind to a CEACAM protein or a functional fragment thereof asdefined herein. In one embodiment, the solid support is a non-cellularsolid support. Such non-cellular solid supports may comprise supportmaterials such as polymers, in particular bioadhesive cationic polymers(e.g., chitosan, polygalactosamine, polylysine, diethylaminoethyldextran(DEAE), DEAE-imine). The support may have any possible structuralconfiguration as long as the molecule bound thereto is able to bind toits respective binding partner (e.g., Helicobacter bacteria). Suitableconfigurations include spherical configurations, such as microspheres(see, for example, WO 2013/164652 A2). In one embodiment, the solidsupport is a microsphere.

The present invention further provides an inhibitor of the interactionbetween Helicobacter bilis (H. bilis) and a member of thecarcinoembryonic antigen-related cell adhesion molecule (CEACAM) familyfor use in a method of preventing or treating a disease or disordercaused by or associated with H. bilis.

The present invention further provides the use of an inhibitor of theinteraction between H. bilis and a member of the carcinoembryonicantigen-related cell adhesion molecule (CEACAM) family in thepreparation of a medicament for preventing or treating a disease ordisorder caused by or associated with H. bilis.

The present invention further provides a method of preventing ortreating a disease or disorder caused by or associated with H. bilis ina subject, said method comprising administering an inhibitor of theinteraction between H. bilis and a member of the carcinoembryonicantigen-related cell adhesion molecule (CEACAM) family to the subject.

According to the present invention, a disease or disorder caused by orassociated with H. bilis is preferably selected from the groupconsisting of H. bilis infection, cholecystitis, gallstone(s),gallbladder cancer and bile duct cancer.

In one embodiment, the inhibitor inhibits, e.g., competitively inhibits,binding of H. bilis to the member of the CEACAM family, preferably to anextracellular domain of the member of the CEACAM family, more preferablyto the N-domain of the member of the CEACAM family.

In one embodiment, the member of the CEACAM family is expressed on thesurface of epithelial cells, endothelial cells and/or immune cells (inparticular leukocytes, such as T cells, B cells and neutrophils). In oneembodiment, the member of the CEACAM family is expressed on the surfaceof epithelial cells (e.g., bile duct epithelial cells), preferably atthe apical side of epithelial cells.

In one embodiment, the member of the CEACAM family is selected from thegroup consisting of human CEACAM family members, non-human primateCEACAM family members and rat CEACAM family members. In one embodiment,the member of the CEACAM family is selected from the group consisting ofCEACAM1, CEACAM5 and CEACAM6.

In one embodiment, the inhibitor is selected from the group consistingof

(a) (poly-)peptide ligands or peptidomimetic ligands binding to themember of the CEACAM family, preferably to an extracellular domain ofthe member of the CEACAM family, more preferably to the N-domain of themember of the CEACAM family;

(b) nucleic acid molecules encoding the (poly-)peptide ligands of (a);

(c) nucleic acid ligands binding to the member of the CEACAM family,preferably to an extracellular domain of the member of the CEACAMfamily, more preferably to the N-domain of the member of the CEACAMfamily;

(d) inhibitory nucleic acid molecules inhibiting the expression of themember of the CEACAM family; and

(e) small molecules binding to the member of the CEACAM family,preferably to an extracellular domain of the member of the CEACAMfamily, more preferably to the N-domain of the member of the CEACAMfamily.

In one embodiment, the inhibitor is comprised in a pharmaceuticalcomposition.

The present invention further provides an in vitro method foridentifying a drug candidate for preventing or treating a disease ordisorder caused by or associated with H. bilis, the method comprising

(a) contacting (i) a CEACAM protein or a functional fragment thereofwith (ii) H. bilis and (iii) a test compound, and

(b) determining whether the test compound inhibits the interactionbetween the CEACAM protein or the functional fragment thereof and H.bilis,

wherein a test compound inhibiting the interaction between the CEACAMprotein or the functional fragment thereof and H. bilis is identified asa drug candidate for preventing or treating a disease or disorder causedby or associated with H. bilis.

In one embodiment, step (b) comprises determining whether the testcompound inhibits binding of H. bilis to the CEACAM protein or thefunctional fragment thereof, wherein, preferably, the functionalfragment of the CEACAM protein comprises an extracellular domain or afragment thereof, preferably the N-domain.

In one embodiment, the CEACAM protein is selected from the groupconsisting of human CEACAM proteins, non-human primate CEACAM proteinsand rat CEACAM proteins. In one embodiment, the CEACAM protein isselected from the group consisting of CEACAM1, CEACAM5 and CEACAM6.

In one embodiment, the test compound is selected from the groupconsisting of (poly-)peptides, peptidomimetics, nucleic acid moleculesand small molecules.

In another aspect, the present invention relates to the use of a CEACAMprotein or a functional fragment thereof being able to interact with H.bilis for studying H. bilis infection or identifying a drug candidatefor preventing or treating a disease or disorder caused by or associatedwith H. bilis.

In a further aspect, the present invention relates to the use of a cellheterologously expressing a CEACAM protein or a functional fragmentthereof being able to interact with H. bilis for studying H. bilisinfection or identifying a drug candidate for preventing or treating adisease or disorder caused by or associated with H. bilis.

In yet another aspect, the present invention relates to the use of anon-human transgenic animal heterologously expressing a CEACAM proteinor a functional fragment thereof being able to interact with H. bilisfor studying H. bilis infection or identifying a drug candidate forpreventing or treating a disease or disorder caused by or associatedwith H. bilis.

In one embodiment of the above uses, the CEACAM protein is selected fromthe group consisting of human CEACAM proteins, non-human primate CEACAMproteins and rat CEACAM proteins. In one embodiment, the CEACAM proteinis selected from the group consisting of CEACAM1, CEACAM5 and CEACAM6.

The present invention further provides a CEACAM protein or a functionalfragment thereof being able to interact with H. bilis for use in amethod of preventing or treating a disease or disorder caused by orassociated with H. bilis, wherein the CEACAM protein or functionalfragment thereof is attached to a solid support, preferably anon-cellular solid support.

The present invention further provides the use of a CEACAM protein or afunctional fragment thereof being able to interact with H. bilis in thepreparation of a medicament for preventing or treating a disease ordisorder caused by or associated with H. bilis, wherein the CEACAMprotein or functional fragment thereof is attached to a solid support,preferably a non-cellular solid support,

The present invention also provides a method of preventing or treating adisease or disorder caused by or associated with H. bilis in a subject,said method comprising administering a CEACAM protein or a functionalfragment thereof being able to interact with H. bilis to the subject,wherein the CEACAM protein or functional fragment thereof is attached toa solid support, preferably a non-cellular solid support.

In one embodiment of the above uses, the CEACAM protein is selected fromthe group consisting of human CEACAM proteins, non-human primate CEACAMproteins and rat CEACAM proteins. In one embodiment, the CEACAM proteinis selected from the group consisting of CEACAM1, CEACAM5 and CEACAM6.

The agents and compositions described herein may be administered via anyconventional route, such as by enteral administration or by parenteraladministration including by injection or infusion. In one embodiment,administration is parenterally, e.g., intradermally, subcutaneously orintramuscularly. In one embodiment, mucosal administration is used,e.g., orally or sublingually.

The agents and compositions described herein are administered ineffective amounts. An “effective amount” refers to the amount, whichachieves a desired reaction or a desired effect alone or together withfurther doses. In the case of treatment of a particular disease or of aparticular condition, the desired reaction preferably relates toinhibition of the course of the disease. This comprises slowing down theprogress of the disease and, in particular, interrupting or reversingthe progress of the disease. The desired reaction in a treatment of adisease or of a condition may also be delay of the onset or a preventionof the onset of said disease or said condition. An effective amount ofan agent or composition described herein will depend on the condition tobe treated, the severeness of the disease, the individual parameters ofthe subject, including age, physiological condition, size and weight,the duration of treatment, the type of an accompanying therapy (ifpresent), the specific route of administration and similar factors.Accordingly, the doses administered of the agents described herein maydepend on various of such parameters. In the case that a reaction in asubject is insufficient with an initial dose, higher doses (oreffectively higher doses achieved by a different, more localized routeof administration) may be used.

The present invention further provides a kit comprising (i) an inhibitoror (ii) an immunogenic composition or (iii) a CEACAM protein orfunctional fragment thereof as defined herein.

As used herein, the term “kit of parts (in short: kit)” refers to anarticle of manufacture comprising one or more containers and,optionally, a data carrier. Said one or more containers may be filledwith one or more of the means or reagents disclosed herein. Additionalcontainers may be included in the kit that contain, e.g., diluents,buffers and further reagents. Said data carrier may be anon-electronical data carrier, e.g., a graphical data carrier such as aninformation leaflet, an information sheet, a bar code or an access code,or an electronical data carrier such as a floppy disk, a compact disk(CD), a digital versatile disk (DVD), a microchip or anothersemiconductor-based electronical data carrier. The access code may allowthe access to a database, e.g., an internet database, a centralized, ora decentralized database. Said data carrier may comprise instructionsfor the use of the kit in accordance with the present invention.

The present invention is further illustrated by the following examples,which are not to be construed as limiting the scope of the invention.

EXAMPLES Example 1 H. pylori Binds to CEACAMs Expressed in Human Stomach

Using pull-down and flow cytometric approaches a robust interaction ofthe H. pylori strain G27 with recombinant human CEACAM1-Fc (FIG. 1a )was found, comparable to that of Moraxella catarrhalis (FIGS. 2a and b). As negative control, Moraxella lacunata did not bind to humanCEACAM1, nor did Campylobacter jejuni, a pathogen closely related to H.pylori (FIGS. 2a and b ). When testing for CEACAM specificity, a clearinteraction of H. pylori with CEACAM5 and 6, but not with CEACAM8 wasobserved (FIG. 1b ), and comparison of the respective N-domainsindicated several residues conserved in CEACAM1, 5, and 6 but not inCEACAM8 (FIG. 2h ). H. pylori interacted also with CEACAM3 (FIGS. 2c andd ). Importantly, all H. pylori strains tested so far bound to theseCEACAMs (FIGS. 2f and g ) including well-characterized reference strains(26695, J99) and the mouse-adapted strain SS1. However, binding strengthdiffered among strains, with some preferentially binding to CEACAM1, andothers to CEACAM5 and/or CEACAM6 (FIGS. 2f and g ). Strikingly, CEACAM1binders were mostly from the group of highly virulent strains,possessing the cag pathogenicity island (cagPAI) encoding a type IVsecretion system (T4SS) for delivery of CagA, while TX30 as a classicalcagPAI-negative strain showed preferred binding to CEACAM5 and 6 (FIGS.2f and g ). The inventors then analyzed the expression profiles ofCEACAM1, CEACAM5 and CEACAM6 in normal and inflamed human stomachtissues and gastric cancer. CEACAM1 and CEACAM5 were expressed at theapical side of epithelial cells, and their expression, as well as thatof CEACAM6, was up-regulated upon gastritis and in gastric tumors (FIG.1c and FIG. 2e ). During infection, H. pylori-induced responses may thuslead to increased expression of its CEACAM-receptors.

The inventors found that H. pylori bound to the N-domain of CEACAM1(FIG. 1d ), since recombinant CEACAM1ΔN did not interact with thebacteria, and further observed binding of H. pylori to all CEACAMscontaining the N-domain, as well as to the N-domain alone (FIG. 1e ).However, binding to the N-domain alone was weaker than to the N-A1-BCEACAM1 variant, which bound less than the N-A1-B-A2 variant (FIG. 1e ),indicating that these domains stabilize the CEACAM1-H. pyloriinteraction, while binding was only partially dependent on glycosylation(FIG. 10. This CEACAM-binding property provides H. pylori robustepithelial adherence independent of the Lewis blood group antigens usedby the BabA and SabA adhesins. While over-expression of CEACAMs ingastrointestinal tumors is well described, their upregulation during H.pylori-induced inflammation in the stomach has not been reported so far,suggesting the pathogen has the ability to shape its own adhesive niche.A plausible route to CEACAM modulation is through the transcriptionfactors NF-κB and AP1, both of which are induced during H. pyloriinfection and are known to regulate CEACAM expression. The up-regulationof these CEACAM-receptors may compensate for the described loss of BabAexpression during colonization, enabling a persistent colonization.

Example 2 Species Specificity of Helicobacter—CEACAM Interaction

H. pylori has been described so far only to infect human and non-humanprimates. Although CEACAMs are found in most mammalian species, and havea high degree of conservation, the inventors found H. pylori to bindselectively to human, but not to mouse, bovine or canine CEACAM1orthologues (FIG. 3a ). However, surprisingly a strong interaction of H.pylori strains with rat-CEACAM1 was found (FIGS. 3b and d ). Also here,this interaction was mediated through the N-domain of rat-CEACAM1 (FIGS.3c and d ). To substantiate these findings, the inventors transfectedhuman, mouse or rat-CEACAM1 into CHO cells, which normally do not permitH. pylori adherence. Using confocal laser scanning microscopy, theyobserved de novo adhesion of H. pylori to CHO cells expressing human andrat, but not mouse CEACAM1 (FIG. 3e ), which could be confirmed by pulldown and western blotting of lysates from transfected cells (FIG. 3f andFIG. 4d ). This finding makes H. pylori the first pathogen for which itsCEACAM binding is not restricted to one species. Comparing the proteinsequences of the CEACAM1-N domains, several amino acids conserved inhuman and rat differ in mouse (i.e. asn10, glu26, asn42, tyr48, pro59,thr66, asn77, val79, val89, ile90, glu103, tyr108) (FIG. 4a ). Inaddition, their findings of a lack of binding to mouse CEACAM1 mayexplain the differences seen in pathology between infected mice andhumans.

The genus Helicobacter comprises several other spp., i.e. H. felis,suis, and bizzozeronii as well as the human pathogenic H. bilis andheilmannii. When assessing the interaction of these Helicobacters withhuman CEACAMs, only H. bilis bound to hu-CEACAM1, 5 and 6 (FIGS. 4b andc ). As H. pylori, H. bilis interacted with the N-domain of hu-CEACAM1(FIGS. 4b and c ). This interaction may explain how H. bilis manages tocolonize human bile ducts, where high levels of constitutively expressedCEACAM1 are present.

Example 3 HopQ is the Helicobacter Adhesin Interacting with CEACAMs

In order to identify the CEACAM-binding partner in Helicobacter, theinventors initially screened a number of Helicobacter mutants devoid ofdefined virulence factors that have been shown to be implicated invarious modes of host cell interaction (BabA, SabA, AlpA/B, VacA, gGT,urease and the CagPAI). All of these mutants still bound to hu-CEACAM1(FIG. 5a ). Therefore, they established an immunoprecipitation approach(FIG. 6a ) using H. pylori lysate and recombinant hu-CEACAM1-Fc coupledto protein G. Mass spectrometric analysis of the co-precipitateidentified two highly conserved H. pylori outer membrane proteins ascandidate CEACAM1 adhesins: HopQ and HopZ (FIG. 5b ). Unlike a hopZmutant, a hopQ deletion mutant was devoid of CEACAM1 binding (FIG. 5c ).Importantly, the hopQ mutant was also unable to bind to CEACAM5 and 6(FIG. 5c ).

Next, the inventors tested the binding of recombinant HopQ to differentgastric cancer cell lines and found that HopQ interacted with AGS andMKN45 both endogenously expressing CEACAMs (FIG. 6b ). HopQ did not bindto the CEACAM negative cell line MKN28. Utilizing their CHOtransfectants, the inventors found that the recombinant HopQ interactedpreferentially with CEACAM1 and 5, and to lesser extent to CEACAM3 and6. No binding was observed to CHO cells expressing either CEACAM4, 7, or8 (FIG. 6c ).

HopQ is a member of a H. pylori-specific family of outer membraneproteins, and shows no significant homology to other CEACAM-bindingadhesins from other Gram-negative bacteria, i.e. Opa proteins or UspA1from Neisseria meningitidis and Neisseria gonorrhoeae or Moraxellacatarrhalis, respectively, and is therefore a novel bacterial factorhijacking CEACAMs. Like Opa and UspA1, HopQ targets the N-terminaldomain in CEACAMs, an interaction the inventors found to require foldedprotein and to be dependent on CEACAM sequence, resulting in specificityfor human CEACAM1, 3, 5 and 6. H. pylori hopQ (omp27; HP1177 in the H.pylori reference strain 26695) exhibits genetic diversity thatrepresents two allelic families (Cao & Cover, 2002), type-I and type-II(FIG. 6d ), of which the type-I allele is found more frequently incag(+)/type s1-vacA strains. Both alleles share 75 to 80% nucleotidesequences and exhibit a homology of 70% at the amino acid level (Cao &Cover, 2002). The inventors observed allelic differences in HopQ'sbinding strength towards CEACAMs, whereby hopQ type-I alleles seem tobind stronger to CEACAM1, while type-II alleles, as found in strainTX30, favor CEACAM5 and 6. Importantly, hopQ genotype shows a geographicvariation, with the hopQ type-I alleles more prevalent in Asian comparedto Western strains; and was also found to correlate with strainvirulence, with type-I alleles associated with higher inflammation andgastric atrophy.

Example 4 Structure and Binding Properties of the HopQ Adhesin Domain

HopQ belongs to a paralogous family of H. pylori outer membrane proteins(Hop's), to which also the blood group antigen binding adhesins BabA andSabA belong. To gain insight into its structure-function relationshipthe inventors determined the X-ray structure of a HopQ fragmentcorresponding to its predicted extracellular domain (residues 17-443 ofthe mature protein, i.e., after removal of the signal peptide;HopQ^(AD); FIG. 7a and Table 1). HopQ^(AD) showed strong, dose dependentbinding to the N-terminal domain of human CEACAM1 (C1ND; residues35-142) in ELISA (FIG. 7b ). Binding profiles measured by isothermaltitration calorimetry (ITC) of HopQ^(AD) titration with C1ND revealed a1:1 stoichiometry with a dissociation constant Kd of 296±40 nM (FIG. 8a).

The HopQ^(AD) X-ray structure shows that, like BabA and SabA, the HopQectodomain adopts a 3+4-helix bundle topology, though lacks the extendedcoiled-coil “stem” domain that connects the ectodomain to thetransmembrane region (FIG. 8d ). In BabA, the carbohydrate binding siteresides fully in a 4-stranded beta-domain that is inserted betweenhelices H4 and H5 (FIG. 8d ). In HopQ, a 2-stranded beta-hairpin isfound in this position (residues 180-218). Removal of the beta-hairpinresulted in a stable protein that showed a ˜10 fold reduction of CEACAM1binding affinity, indicating that although the HopQ insertion domain isimplicated in binding, it does not comprise the full binding site asfound in BabA (FIG. 7b ). The BabA and SabA adhesins are lectins thatbind Lewis b and sialylated Lewis x and a glycans, respectively. Toverify if the HopQ-CEACAM interaction is similarly glycan-driven, theinventors evaluated HopQ binding to C1ND under native or denaturedconditions. Far western analysis revealed that HopQ specifically boundfolded, but not denatured CEACAM1-N (FIG. 7c ). In contrast, bacterialpull-down experiments showed only a minor reduction in binding uponCEACAM1-Fc deglycosylation (FIG. 10, corroborating that protein-proteininteractions form the major contributor to HopQ-CEACAM binding.

TABLE 1 Data collecton and refinement statistics for the HopQ^(AD)structure. HopQ^(AD) Data collection Space group P 1 2₁ 1 Celldimensions a, b, c (Å) 57.7, 57.7, 285.7 α, β, γ (°) 90.0, 90.1, 90.0 Resolution (Å) 49.38-2.6 (2.74-2.6)* R_(merge) 14.7 (121.0)* I/σI 7.3(0.9)* CC½ 99.3 (57.6)*^(‡) Completeness (%) 99.7 (98.2)* Redundancy 4.7(4.5)* Refinement Resolution (Å) 285.6-2.6 No. reflections 55541R_(work/)R_(free) 20.9/23.6 No. atoms Protein 10946 Water 35 B-factorsProtein 42.8 Water 60.7 R.m.s deviations Bond lengths (Å) 0.014 Bondangles (°) 1.71 *Highest resolution shell is shown in parenthesis.^(‡)Resolution limits were determined by applying a cut-off based on themean intensity correlation coefficient of half-datasets (CC½)approximately of 0.5.

Example 5 HopQ—CEACAM1 Interaction Triggers Cell Responses

To further investigate how HopQ may influence adhesion and cellularresponses, the inventors sought to establish cellular pathogenesismodels in which the HopQ-CEACAM-mediated adhesion could be analyzed.Therefore, the inventors characterized various gastric cell linestypically employed for H. pylori in vitro experiments regarding theirexpression of CEACAMs, and observed that MKN45, KatoIII and AGS didexpress CEACAM1, CEACAM5 and CEACAM6, whereas MKN28 showed no presenceof CEACAMs (FIGS. 10a and b ). CHO cells were stably transfected withCEACAM1-L (containing the ITIM motif). Upon infection with H. pyloriwild-type strain P12 and its isogenic hopQ deletion mutant, theinventors observed a significantly reduced adherence to CHO-CEACAM1-L,MKN45 and AGS cells, while strains deficient in the adhesins BabA andSabA showed only slightly reduced adhesion (FIG. 9a ). In CHO-CEACAM1-Lcells, the inventors observed tyrosine-phosphorylation of the CEACAM1ITIM domain upon exposure to H. pylori, which was apparent within 5minutes, and was maintained for up to 1 hour (FIG. 9b ). Phosphorylationof the CEACAM1 ITIM domain is a well-known initial event triggeringSHP1/2 recruitment inducing downstream signaling cascades.Contact-dependent signaling through CEACAMs is a common means ofmodulating immune responses related to infection, inflammation andcancer, and these immune-dampening cascades likely reflect the multipleindependent emergence of non-homologous CEACAM-interacting proteins indiverse mucosal Gram-negative pathogens including Neisseria,Haemophilus, Escherichia, Salmonella, Moraxella sp. For H. pylori,interaction with human CEACAM1 through HopQ may represent a criticalparameter for immuno-modulatory signaling during colonization andchronic infection of man.

Additionally, hopQ mutant H. pylori strains showed an almost completeloss of T4SS-dependent CagA translocation (FIG. 9c ) and stronglyreduced IL-8 induction (FIG. 9d ), while loss of other known adhesinshad no effect on CagA delivery (FIGS. 10c and d ).

To corroborate these data in an independent model and compensate forpotential clonal effects in stably transfected cells, the inventorstransiently transfected HEK293 cells with human CEACAM (1-L, 3, 4, 5, 6,7, 8) expression plasmids. Infection of these cells confirmed the defectin CagA translocation observed in CHO-CEACAM1-L cells, which wasrestored upon complementation of the hopQ mutant strain (P12ΔhopQ/hopQ)(FIG. 9e and FIG. 10e ). Also, cellular elongation, the so called“hummingbird phenotype”, was significantly reduced upon deletion of hopQ(FIGS. 9f and g ). Further, the inventors observed that H. pylorimodulates important host transcription factors such as Myc, STAT3,CreATF2/CREB, GRE and NF-κB in a hopQ-dependent fashion (FIG. 10f ).These results reveal that HopQ-CEACAM binding leads to direct andindirect alterations in host cell signaling cascades, and start to shedlight on these HopQ-associated virulence landscapes. Given theimportance of these signaling events for gastric carcinogenesis, theinventors explored if the CEACAM-HopQ interaction could be targeted inorder to prevent CagA translocation and downstream effects. Indeed,using an α-CEACAM1 antibody, α-HopQ antiserum or a HopQ-derived peptidecorresponding to the Hop-ID (aa 190-218) reduced CagA translocation in adose dependent manner (FIG. 9h-j ), but not corresponding controls (FIG.10g ). These data demonstrate that the HopQ-CEACAM1 interaction isnecessary for successful translocation of the oncoprotein CagA intoepithelial cells as well as modulation of inflammatory signaling, andthat interference with this interaction can prevent CagA translocation,giving an indication of the translational potential of HopQ targeting H.pylori vaccination or immunotherapy.

Example 6 Deletion of HopQ Abrogates Colonization in a Rat Model of H.pylori Infection

As the inventors found binding of HopQ to human and rat, but not tomouse CEACAM, they determined the role of HopQ in vivo, using a ratmodel of H. pylori infection. Having observed that CEACAM1 was expressedin normal rat stomach (FIG. 11a and FIG. 12b ), the inventors infectedrats with different H. pylori strains known to infect rodents. While allstrains bound to rat CEACAM1 in vitro, only SS1 was able to efficientlycolonize rats (FIG. 12a ). The hopQ deficient SS1 strain was not able tocolonize rats at detectable levels, and could not induce an inflammatoryresponse in comparison to the wild type SS1 strain (FIGS. 11b and c ).Therefore, in this model, HopQ seems also to serve as an importantfactor to mediate H. pylori colonization.

Example 7 Structure of a HopQ^(AD) and C1ND Complex

The structure of a complex between the HopQ adhesin domain andnon-glycosylated N-terminal domain of human CEACAM1 recombinantlyproduced and purified from E. coli was determined (FIG. 13a and Table2). The structure shows that the contact surface of HopQ that binds theCEACAM N-terminal domain is formed by three extended loops: HopQ_123-136(loop A), HopQ_152-180 (loop B) and HopQ_258-290 (loop C). The bindingconformation of loop HopQ_123-136 is stabilized by main chain hydrogenbonding with the β-hairpin formed by the HopQ-ID. Accordingly, deletionof the HopQ-ID was found to result in a drastic reduction in HopQ-CEACAMbinding. A fourth extended loop on the HopQ adhesin domain, HopQ_371-407(loop D), lies adjacent to the HopQ-CEACAM binding interface. Althoughno direct contact is made between HopQ_371-407 and the CEACAM N-domain,antibodies or antibody derivatives that bind HopQ_371-407 will disruptthe HopQ-CEACAM interaction by steric hindrance.

TABLE 2 Data collection and refinement statistics for theHopQ^(AD)-hC1ND structure. HopQ^(AD)-hC1ND Data collection Space groupC2 Cell dimensions a, b, c (Å) 118.0, 174.0, 118.1 α, β, γ (°) 90.0,118.4, 90.0 Resolution (Å) 50.00-3.55 (3.64-3.55)* R_(merge) 11.8(88.0)* I/σI 8.0 (1.6)* CC½ 99.5 (59.7)* Completeness (%) 99.3 (99.5)*Redundancy 3.8 (3.8)* Refinement Resolution (Å) 48.81-3.55 No.reflections 25252 R_(work/)R_(free) 28.1/33.8 No. atoms Protein 9621Water 0 B-factors Protein 81.5 Water NA R.m.s deviations Bond lengths(Å) 0.008 Bond angles (°) 1.12 *Highest resolution shell is shown inparenthesis. ‡ Resolution limits were determined by applying a cut-offbased on the mean intensity correlation coefficient of half-datasets(CC½) approximately of 0.5.

Materials and Methods

Bacteria and Bacterial Growth Conditions

The H. pylori strains G27, PMSS1, SS1, J99 (ATCC, 700824), 2808, 26695(ATCC, 70039), TX30, 60190, P12, NCTC11637 (ATCC, 43504), Ka89 and H.bilis (ATCC43879) were grown on Wilkins-Chalgren blood agar plates undermicroaerobic conditions (10% CO2, 5% O2, 8.5% N2, and 37° C.). H. suisand H. heilmannii were grown on Brucella agar and H. felis (ATCC 49179)and H. bizzozeronii on brain-heart infusion (BHI) agar supplemented with10% horse blood. Moraxella catarrhalis (ATCC, 25238), Moraxella lacunata(ATCC 17967) and Campylobacter jejunei (ATCC, 33560) were cultured onbrain-heart infusion (BHI) agar supplemented with 5% heated horse bloodovernight at 37° C. in a CO₂ incubator. The generation of an isogenicΔhopQ mutant was done by replacement of the entire gene by achloramphenicol resistance cassette as described (Belogolova et al.,2013).

Production of CEACAM Proteins

The cDNA, which encodes the extracellular domains of human CEACAM1-Fc(consisting of N-A1-B1-A2 domains), human CEACAM1dN-Fc (consisting ofA1-B1-A2), rat CEACAM1-Fc (consisting of N-A1-B1-A2), rat CEACAM1dN-Fc(consisting of A1-B1-A2), human CEACAM3-Fc (consisting of N), humanCEACAM6-Fc (consisting of N-A-B), human CEACAM8-Fc (consisting ofN-A-B), respectively, were fused to a human heavy chain Fc-domain andcloned into the pcDNA3.1(+) expression vector (Invitrogen, San Diego,Calif.), sequenced and stably transfected into HEK293 (ATCC CRL-1573)cells as described (Singer et al., 2014). The Fc chimeric CEACAM-Fcproteins were accumulated in serum-free Pro293s-CDM medium (Lonza) andwere recovered by Protein A/G-Sepharose affinity Chromatography(Pierce). Proteins were analyzed by SDS-PAGE and stained by Coomassieblue demonstrating an equal amount and integrity of the produced fusionproteins (FIG. 2i ). Recombinant-human CEACAM5-Fc was ordered from SinoBiological Inc. For production of the recombinant human CEACAM1 N-Domain(C1ND), the annotated domain (UniProt ID: P13688) was firstbacktranslated using the GeneOptimizer® (LifeTechnologies) and theleader sequence of the Igk-chain as well as a C-terminal Strep-Tag IIwas added. The gene was synthesized and seamlessly cloned intopCDNA3.4-TOPO (LifeTechnologies). Protein was produced in a 2 L cultureof Expi293 cells according to the Expi293 expression system instructions(LifeTechnologies). The resulting supernatant was concentrated anddiafiltered against ten volumes of 1× SAC buffer (100 mM Tris, 140 mMNaCl, 1 mM EDTA, pH 8.0) by crossflow-filtration, using a Hydrosart 5kDa molecular-weight cutoff membrane (Sartorius). The retentate wasloaded onto a StrepTrap HP column (GE Healthcare) and eluted with 1× SACsupplemented with 2.5 mM D-Desthiobiotin (IBA). The protein was storedat +4° C.

For the bacterial expression of the C1ND (Ec-C1ND), the amino acidsequence was codon-optimized for expression in E. coli, synthesized byGeneArt de novo gene synthesis (Life Technologies), and cloned with aC-terminal His6 tag in the pDEST™ 14 vector using Gateway technology(Invitrogen). E. coli C43(DE3) cells were transformed with the resultingconstruct and grown in LB supplemented with 100 μg/mL ampicillin at 37°C. while shaking. At OD₆₀₀=1, Ec-C1ND expression was induced with 1 mMIPTG overnight at 30° C. Cells were collected by centrifugation at 6.238g for 15 minutes at 4° C. and resuspended in 50 mM Tris-HCl pH 7.4, 500mM NaCl (4 mL/g wet cells) supplemented with 5 μM leupeptin and 1 mMAEBSF, 100 μg/mL lysozyme, and 20 μg/mL DNase I. Subsequently, cellswere lysed by a single passage in a Constant System Cell Cracker at 20kPsi at 4° C. and debris was removed by centrifugation at 48.400 g for40 minutes. The cytoplasmic extract was filtrated through a 0.45 μm porefilter and loaded on a 5 mL pre-packed Ni-NTA column (GE Healthcare)equilibrated with buffer A (50 mM Tris-HCl pH 7.4, 500 mM NaCl and 20 mMimidazole). The column was then washed with 40 bed volumes of buffer Aand bound proteins were eluted with a linear gradient of 0-75% buffer B(50 mM Tris-HCl pH 7.4, 500 mM NaCl and 500 mM imidazole). Fractionscontaining Ec-C1ND, as determined by SDS-PAGE, were pooled andconcentrated in a 10 kDa MW cutoff spin concentrator to a final volumeof 5 ml. To remove minor protein contaminants, the concentrated samplewas injected onto the Hi-Prep™ 26/60 Sephacryl S-100 HR column (GEHealthcare) pre-equilibrated with a buffer containing 50 mM Tris-HCl pH8.0, 150 mM NaCl. Fractions containing the Ec-C1ND complex were pooledand concentrated using a 10 kDa MW cutoff spin concentrator.

HopQ^(AD) and HopQ^(AD)ΔID Cloning, Production and Purification

In order to obtain a soluble HopQ fragment, the HopQ gene from the H.pylori G27 strain (accession No. CP001173 Region: 1228696 . . . 1230621;SEQ ID NO: 1) was used and a HopQ fragment ranging from residues 37-463was produced (residues 17-443 of the mature protein), thus removing theN-terminal 13-strand and signal peptide, as well as the C-terminalβ-domain expected to represent the TM domain. In HopQ^(AD)ΔID, the aminoacids 190-218 of the mature protein were replaced by two glycines (FIG.8e ). DNA coding sequences corresponding to the HopQ type I fragmentswas PCR-amplified from H. pylori G27 genomic DNA using primers (forward:GTTTAACTTTAAGAAGGAGATATACAAATGGCGGTTCAAAAAGTGAAAAACGC (SEQ ID NO: 8);reverse: TCAAGCTTATTAATGATGATGATGATGGTGGGCGCCGTTATTCGTGGTTG (SEQ ID NO:9)), containing a 30 bp overlap to the flanking target vector sequencesof pPRkana-1, a derivative of pPR-IBA 1 (IBA GmbH) with the ampicillinresistance cassette replaced by the kanamycin resistance cassette, undera T7 promotor. In parallel, the vector was PCR-amplified using primers(forward: CACCATCATCATCATCATTAATAAGCTTGATCCGGCTGCTAAC (SEQ ID NO: 10);reverse: GTTTAACTTTAAGAAGGAGATATACAAATG (SEQ ID NO: 11)), using the sameoverlapping sequences in reversed orientation. The forward primeradditionally carried the sequence for a 6× His-tag. The amplicons wereseamlessly cloned using Gibson Assembly (New England Biolabs GmbH).Based on codon optimized HopQ^(AD) plasmid, the HopQ^(AD)ΔID constructswere cloned. The plasmids were amplified by 5′ phosphorylated primers(forward: GGTGACGCTCAGAACCTGCTGAC (SEQ ID NO: 12); reverse:ACCACCTTTAGAGTTCAGCGGAG (SEQ ID NO: 13)) replacing the ID region by twoglycines, DpnI (NEB) digested and blunt-end ligated by T4 ligase (NEB).

Escherichia coli BL21 (DE3) cells (NEB GmbH) were transformed with thepPRkana-1 constructs, grown at 37° C. with 275 rpm on auto-inducingterrific broth (TRB) according to {Studier:2005ku}, supplemented with 2mM MgSO₄, 100 mg/L Kanamycin-Sulfate (Carl Roth GmbH+Co. KG), 0.2 g/LPPG2000 (Sigma Aldrich) and 0.2% w/v Lactose-monohydrate (SigmaAldrich), until an OD of 1-2 was reached. Afterwards, the temperaturewas lowered to 25° C. and auto-induced overnight, reaching a final OD of10-15 the following morning. Cells were harvested by centrifugation at6000 g for 15 min at 4° C. using a SLA-3000 rotor in a Sorvall RC-6 Pluscentrifuge (Thermo Fischer). Prior to cell disruption, cells wereresuspended in 10 ml cold NiNTA buffer A (500 mM NaCl, 100 mM Tris, 25mM Imidazole, pH 7.4) per gram of biological wet weight (BWW),supplemented with 0.1 mM AEBSF-HCl, 150 U/g BWW DNase I and 5 mM MgCl₂and dispersed with an Ultra-Turrax T25 digital (IKA GmbH+Co. KG). Celldisruption was performed by high-pressure homogenization with aPANDA2000 (GEA Niro Soavi) at 800-1200 bar in 3 passages at 4° C. Thecell lysate was clarified by centrifugation at 25000 g for 30 min at 4°C. in a SLA-1500 rotor and remaining particles removed by filtrationthrough a 0.2 μM filter. HopQ fragments were purified by consecutivenickel affinity and size exclusion chromatography. Briefly, theclarified cell lysate was loaded onto a 5 ml pre-packed Ni-NTA HisTrapFF crude column (GE Healthcare) pre-equilibrated with buffer A, washedwith ten column volumes (CV) of buffer A and the bound protein elutedwith a 15 CV linear gradient to 75% NiNTA buffer B (500 mM NaCl, 100 mMTris, 500 mM Imidazole, pH 7.4). Eluted peak fractions were collected,pooled and concentrated to a final concentration of 8-10 mg ml⁻¹ using a10 kDa molecular-weight cutoff spin concentrator. Subsequently, 5 ml ofthe concentrated protein were loaded onto a HiLoad 16/600 Superdex 75 pgcolumn (GE Healthcare) pre-equilibrated with Buffer C (5 mM Tris, 140 mMNaCl, pH 7.3) and eluted at 1 ml min⁻¹. Finally, only proteincorresponding to the monomer-peak was pooled and stored at +4° C. priorto crystallization. For analyzing the multimerization state ofHopQ^(AD), SEC was performed on a Superdex 200 10/300 GL (GE Healthcare)with 24 ml bed volume. The column was pre-equilibrated with Buffer C andsubsequently, 25 μg protein injected and separated with a flow rate of0.5 ml/min.

The HopQ insertion domain (HopQ-ID) representing peptide was HA-tagged,synthesized

(EKLEAHVTTSKYQQDNQTKTTTSVIDTTNYPYDVPDYA (SEQ ID NO:14, HA-tag underlined))and HPLC purified (Peptide Specialty Laboratories, Heidelberg, Germany).For cellular assays, the lyophilized peptide was dissolved in sterilePBS to a concentration of 1 mM and dialysed with a 0.1-0.5 kDamolecular-weight cutoff membrane against PBS to remove remaining TFA.The peptide solution was stored at −20° C. until further use.

TABLE 3 HopQ sequences. UniProt Reference Cluster 90% H. sequence pyloriUniProt identity SEQ ID NO Protein Strain ID (July 2016) (Protein/DNA)Comment(s) HopQ G27 — — 1/2 Accession No. Type I CP001173, Region:1228696 . . . 1230621 HopQ 26695 O25791 173 3/4 Also referred to as TypeI Omp27 and HP1177 HopQ P12 H6A3H4 173 15/16 — Type I HopQ Tx30a Q8GDI677 5/6 — Type II trxA J99 P66929 231 — — (reference)

Detection of the HopQ-CEACAM Interaction by ELISA

For detection of the interaction between CEACAM and HopQ^(AD),recombinant C1ND (1 μg/ml) in PBS was coated over night at 4° C. onto a96-well immunoplate (Nunc MaxiSorb). Wells were blocked with SmartBlock(Candor) for 2 h at RT. Subsequently, HopQ fragments were added in afivefold series dilution ranging from 10 μg/ml to 0.05 ng/ml for 2 h atroom temperature. Next, an α-6×His-HRP conjugate (clone 3D5,LifeTechnologies) was diluted 1:5000 and incubated for 1 h at roomtemperature. For detection, 1-Step™ Ultra TMB-ELISA Substrate Solution(LifeTechnologies) was used and the enzymatic reaction was stopped with2N H₂SO₄. Washing (3-5×) in between incubation steps was carried outwith PBS/0.05% Tween20.

Isothermal Titration Calorimetry

ITC measurements were performed on a MicroCal iTC200 calorimeter(Malvern). Either HopQ^(AD) type I (50 μM) or C1ND (25 μM) was loadedinto the cell of the calorimeter and respectively CEACAM (50 μM or 500μM) or HopQ^(AD) type I (250 μM) was loaded in the syringe. Allmeasurements were done at 25° C., with a stirring speed of 600 rpm andperformed in 20 mM HEPES buffer (pH 7.4), 150 mM NaCl, 5% (v/v) glyceroland 0.05% (v/v) Tween-20. Binding data were analyzed using the MicroCalLLC ITC200 software.

SDS-PAGE and Native-PAGE for Western Blot

CEACAM was separated with both SDS-PAGE and native-PAGE (resp. on 15%and 7.5% polyacrylamide gels) in ice-cold 25 mM Tris, 250 mM glycinebuffer. Subsequently, samples were transferred to PVDF-membranes by wetblotting at 25 V during 60 minutes in ice-cold transfer buffer (25 mMTris, 250 mM glycine and 20% methanol). Membranes were blocked duringone hour in 10% milk powder (MP), 1×PBS and 0.005% Tween-20. Bothmembranes were washed and incubated together in 5% MP, 1×PBS, 0.005%Tween-20 in presence of 2 μM HopQ^(AD) type I for one hour to allowcomplex formation between HopQ^(AD) I and CEACAM. After a washing stepthe C-terminal His-tag of HopQ (CEACAM is strep tagged) was detected byadding consecutively mouse α-His (AbD Serotec) and goat α-mouse antibody(Sigma-Aldrich) during respectively one hour and 30 minutes in 5% MP,1×PBS, 0.005% Tween-20. After a washing step, the blot was developed byadding BCIP/NBT substrate (5-bromo-4-chloro-3-indolyl-phosphate/nitroblue tetrazolium) (Roche) in developing buffer (10 mM Tris-HCl pH 9.5,100 mM NaCl, 50 mM MgCl2).

Bacterial Pull-Down

Bacteria were grown overnight on WCdent agar plates. Bacteria werescraped from plates, suspended in PBS, and colony forming units (cfu)were estimated by optical density 600 readings according to a standardcurve. Bacteria were washed twice with PBS and 2×10⁸ cells/ml wereincubated with soluble CEACAM-Fc or CEACAM-GFP proteins or CHO celllysates for 1 h at 37° C. with head-over-head rotation. Afterincubation, bacteria were washed 5 times with PBS and either boiled inSDS sample buffer (62.5 mM Tris-HCl [pH 6.8], 2% w/v SDS, 10% glycerol,50 mM DTT, and 0.01% w/v bromophenol blue) prior to SDS-PAGE and westernblotting or taken up in FACS buffer (PBS/0.5% BSA) for flow cytometryanalysis.

Immunoprecipitation and Mass Spectrometry

Bacteria (2×10⁸) in cold PBS containing protease and phosphataseinhibitors (Roche) were lysed by ultra-sonication on ice (10×, 20 s).Cell debris was removed from the lysates by centrifugation at 15,000 rpmfor 30 min at 4° C., followed by pre-clearing with prewashed proteinG-agarose (Roche Diagnostics). CEACAM1-Fc was added to the lysate (10μg) and incubated for 1 h at 4° C. Prewashed protein G-agarose (60 μL)were added to the antibody and lysate mixture and incubated 2 h at 4° C.Beads were washed with PBS for five times to remove unspecifically boundproteins. Two-thirds of the beads were separated and used for massspectrometry sample preparation. The supernatant was removed and thebeads were resuspended twice in 50 μl 7M urea/2M thiourea solved in 20mM Hepes (pH 7.5) for denaturation of the proteins. Beads were pelletedby centrifugation and supernatants pooled and transferred to a newEppendorf tube. Subsequently, proteins were reduced in 1 mM DTT for 45min and alkylated at a final concentration of 5.5 mM iod acetamide for30 min in the dark. The alkylation step was quenched by raising the DTTconcentration to 5 mM for 30 min. All incubation steps were carried outat RT under vigorous shaking (Eppendorf shaker, 450 rpm). For digestionof the proteins 1 μl LysC (0.5 μg/μl) was added and the sample incubatedfor 4 h at RT. To reduce the urea concentration the sample was diluted1:4 with 50 mM triethylammonium bicarbonate and then incubated with 1.5μl trypsin (0.5 μg/μl) at 37° C. over night. Trypsin was finallyinactivated by acidification with formic acid. The supernatant wastransferred to a new Eppendorf tube and pooled with the following washfraction of the beads with 0.1% formic acid. The sample was adjusted topH 3 with formic acid (100% v/v) and subjected to peptide desalting witha SepPak C18 column (50 mg, Waters). Briefly, the column wassubsequently washed with 1 ml 100% acetonitrile and 500 μl 80%acetonitrile, 0.5% formic acid. The column was equilibrated with 1 ml0.1% TFA, the sample was loaded and the column washed again with 1 ml0.1% TFA. After an additional wash step with 500 μl 0.5% formic acidpeptides were eluted twice with 250 μl 80% acetonitrile, 0.5% formicacid. The organic phase was then removed by vacuum centrifugation andpeptides stored at −80° C. Directly before measurement peptides wereresolved in 20 μl 0.1% formic acid, sonificated for 5 min (water bath)and the sample afterwards filtered with a prewashed and equilibratedfilter (0.45 μm low protein binding filter, VWR International, LLC).Measurements were performed on an LC-MS system consisting of an Ultimate3000 nano HPLC directly linked to an Orbitrap XL instrument (ThermoScientific). Samples were loaded onto a trap column (2 μm, 100 A, 2 cmlength) and separated on a 15 cm C18 column (2 μm, 100 A, ThermoScientific) during a 150 min gradient ranging from 5 to 30%acetonitrile, 0.1% formic acid. Survey spectra were acquired in theorbitrap with a resolution of 60,000 at m/z 400. For proteinidentification up to five of the most intense ions of the full scan weresequentially isolated and fragmented by collision induced dissociation.The received data was analyzed with the Proteome Discoverer Softwareversion 1.4 (Thermo Scientific) and searched against the H. pylori(strain G27) database (1501 proteins) in the SEQUEST algorithm. ProteinN-terminal acetylation and oxidation of methionins were added asvariable modifications, carbamidomethylation on cysteines as staticmodifications. Enzyme specificity was set to trypsin and mass tolerancesof the precursor and fragment ions were set to 10 ppm and 0.8 Da,respectively. Only peptides that fulfilled X_(corr) values of 1.5, 2.0,2.25 and 2.5 for charge states +1, +2, +3 and +4 respectively wereconsidered for data analysis.

Cells, Cell-Bacteria Co-Culture and Elongation Phenotype QuantitationAssay

Gastric cancer cell lines MKN45, KatoIII (ATCC, HTB-103), MKN28 and AGS(ATCC, CRL-1739) were obtained from ATCC and DSMZ, authenticated byutilizing Short Tandem Repeat (STR) profiling, cultured either sparse orto tight confluence in DMEM (GIBCO, Invitrogen, Carlsbad Calif., USA)containing 2 mM L-glutamine (GIBCO, Invitrogen, Calif., USA)supplemented with 10% FBS (GIBCO, Invitrogen, Calif., USA) and 1%Penicillin/Streptomycin (GIBCO, Invitrogen, Calif., USA). All cell lineswere maintained in an incubator at 37° C. with 5% CO2 and 100% humidity,and are routinely mycoplasma-tested twice per year by DAPI stain andPCR. Plate-grown bacteria were suspended in DMEM and washed bycentrifugation at 150 g for 5 min in a microcentrifuge. Afterresuspension in DMEM, the optical density at 600 nm was determined andbacteria were added to the overnight serum-deprived cells at differentratios of bacteria/cell (MOI) at 37° C. to start the infection. Afterthe indicated time, cells were washed twice with PBS and then lysed with1% NP-40 in protease & phosphatase inhibitor PBS. HEK293 cells werechosen for CEACAM transfection studies because the cells were found tobe negative for huCEACAM expression, and are easily transfectable. HEKcells were grown in 6-well plates containing RPMI 1640 medium(Invitrogen) supplemented with 25 mM HEPES buffer and 10%heat-inactivated FBS (Biochrom, Berlin, Germany) for 2 days toapproximately 70% confluence. Cells were serum-deprived overnight andinfected with H. pylori at MOI 50 for the indicated time points in eachfigure. After infection, the cells were harvested in ice-cold PBScontaining 1 mmol/L Na3VO4 (Sigma-Aldrich). Elongated AGS cells in eachexperiment were quantified in 5 different 0.25-mm2 fields using anOlympus IX50 phase contrast microscope.

Transfection

A CHO cell line (ATCC) permanently expressing hu-CEACAM1-4L,mouse-CEACAM1-L and rat-CEACAM1-L were generated by stably transfectingcells with 4 μg pcDNA3.1-huCEACAM1-4L, pcDNA3.1-huCEAC AM1-4S,pcDNA3.1-msCEACAM1-L, pcDNA3.1-ratCEACAM1-L plasmid (Singer),respectively, utilizing the lipofectamine 2000 procedure according tothe manufacturer's protocol (Invitrogen). Stable transfected cells wereselected in culture medium containing 1 mg/ml of Geniticinsulfat (G418,Biochrom, Berlin, Germany). The surface expression of CEACAM1 inindividual clones growing in log phase was determined by flow cytometry(FACScalibur, BD). HEK293 cells were transfected with 4 μg of theHA-tagged CEACAM constructs or luciferase reporter constructs (Clontech,Germany) for 48 h with TurboFect reagent (Fermentas, Germany) accordingto the manufacturer's instructions.

Western Blot

An equal volume of cell lysate was loaded on 8% SDS-PAGE gels and afterelectrophoresis, separated proteins were transferred to nitrocellulosemembrane (Whatman/GE Healthcare, Freiburg, Germany). Membranes wereblocked in 5% non-fat milk for 1 h at room temperature and incubatedovernight with primary antibodies mAb 18/20 binding to CEACAM1, 3, 5,B3-17 and C5-1X (mono-specific for hu-CEACAM1, Singer), 4/3/17 (bindingto CEACAM1, 5, Genovac), and 5C8C4 (mono-specific for hu-CEACAM5,Singer), 1H7-4B (mono-specific for hu-CEACAM6, Singer), 6/40c(mono-specific for hu-CEACAM8, Singer), Be9.2 (α-rat-CEACAM1), mAb 11-1H(α-rat-CEACAM1ΔN, Singer), phosphotyrosine antibody PY-99 (Santa Cruz,LaJolla, Calif., USA), α-CagA phosphotyrosine antibody PY-972, mousemonoclonal α-CagA antibody (Austral Biologicals, San Ramon, Calif.,USA), mouse monoclonal α-CEACAM1 (clone D14HD11 Genovac/Aldevron,Freiburg, Germany) or goat α-GAPDH (Santa Cruz). After washing,membranes were incubated with the secondary antibody [HRP-conjugatedα-mouse IgG (Promega)] and proteins were detected by ECL WesternBlotting Detection reagents. The quantification was done by LabImage 1Dsoftware (INTAS).

Flow Cytometry

The Fc-tagged CEACAMs (2.5 μg/ml) were incubated with H. pylori (OD:1)and subsequently with FITC-conjugated goat α-human IgG (Sigma). Afterwashing with FACS buffer, the samples were analyzed by gating on thebacteria (based on forward and sideward scatter) and measuringbacteria-associated fluorescence. In each case, 10,000 events per samplewere obtained. Analysis was performed with the FACS CyAn (BeckmanCoulter) and the data were evaluated with FlowJo software (Treestar).For the analysis of CEACAM-mediated HopQ binding, indicated cell types(5×10⁵ in 50 μl) were incubated with 20 μg/ml of H. pylori strain P12derived, myc and 6x His-tagged recombinant HopQ diluted in 3% FCS/PBSfor 1 h on ice. After three times washing with 3% FCS/PBS samples werelabeled with 20 μg/ml of mouse α-c-myc mAb (clone 9E10, AbD Serotec) andsubsequently with FITC conjugated goat α-mouse F(ab′)2 (Dianova,Germany). In parallel, the presence of CEACAMs was controlled bystaining cells utilizing the rabbit anti CEA pAb (A0115, Dianova)followed by FITC conjugated goat α-rabbit F(ab′)2 (Dianova, Germany).Background fluorescence was determined using isotype-matched Ig mAb. Thestained cell samples were examined in a FACScalibur flow cytometer (BDBiosciences, San Diego, Calif.) and the data were analyzed utilizing theCellQuest software. Dead cells, identified by PI staining, were excludedfrom the measurement.

Immunohistochemistry

Following approval of the local ethics committee, paraffin-embeddedhuman normal stomach, gastritis and cancer samples were randomly chosenfrom the tissue bank of the Institut für Pathologic, Klinikum Bayreuth,Germany. Histological samples were excluded if tissue quality was poor.After antigen retrieval with 10 mmol/L sodium citrate buffer pH 6 inpressure cooker, the sections were incubated with α-hu-CEACAM1, 5, 6 andα-rat-CEACAM1 antibodies (clone B3-17, 5C8C4, 1H7-4B and Be9.2,respectively). Sections were developed with SignalStain DAB (CellSignaling) following manufacturer's instructions. Sections werecounterstained with hematoxylin (Morphisto). The automated imageacquisition was performed with Olympus Virtual Slide System VS120(Olympus, Hamburg, Germany).

Adherence Assay

The adherence assay was performed according to Hytonen et al., 2006.Briefly, human gastric epithelial cells (MKN45 and AGS) andCEACAM1-transfected CHO cells were grown in antibiotic free DMEM (Gibco,Gaithersburg, Md.) supplemented with 5% FCS and 1-glutamine (2 mmol,Sigma, St. Louis, USA) on tissue culture 96 well plates (Bioscience) in5% CO2 atmosphere for 2 days. To visualize H. pylori cells in adhesionassays, OD: 1 of bacteria were fluorescence labeled with CFDA-SE(Molecular Probes) and washed with PBS. CFDA-SE was added atconcentration of 10 μmol/L for 30 min at 37° C. under constant rotationin the dark. Excess dye was removed by 3 times PBS washing. Bacteriawere resuspended in PBS until further use. Labelled bacteria wereco-incubated (MOI 10) with the cells at 37° C. with gentle agitation for1 h. After washing with PBS (1 ml, ×3) to remove non-adherent bacteria,cells were fixed in paraformaldehyde (2%, 10 min). Bacterial binding wasdetermined by measuring the percentage of cells that boundfluorescent-labeled bacteria using flow cytometry analysis.

IL-8 Cytokine ELISA

AGS cell line was infected with H. pylori as described above andPBS-incubated control cells served as negative control. The culturesupernatants were collected and stored at −20° C. until assayed. IL-8concentration in the supernatant was determined by standard ELISA withcommercially available assay kits (Becton Dickinson, Germany) accordingto described procedures.

HopQ-Dependency of CagA Virulence Pathways

If not indicated otherwise, the AGS cell line (ATCC CRL-1730) wasinfected with the various H. pylori strains for 6 hours at amultiplicity of infection (MOI) of 50. The cells were then harvested inice-cold PBS in the presence of 1 mmol/L Na3VO4 (Sigma-Aldrich). In eachexperiment the number of elongated AGS cells was quantified in 10different 0.25-mm2 fields using a phase contrast microscope (OlympusIX50). CagA translocation was determined using the indicated antibodiesdetecting Tyr-phosphorylated CagA. All experiments were performed intriplicates. For inhibition experiments, cells were incubated with theindicated antibodies or peptides prior to infection.

Confocal Microscopy

CHO cells were grown on chamber slides (Thermo Scientific), fixed inparaformaldehyde (4%, 10 min) and blocked with PBS/5% bovine serumalbumin. CFDA-SE labelled bacteria (10 μmol/L for 30 min at 37° C. underconstant rotation in the dark) at MOI 5 were incubated with cells for 1h at 37° C. under constant rotation. After 5× PBS washing, cellmembranes were stained with Deep Red (Life Technology) and cell nucleiwith DAPI (Life Technology). Confocal images of cells were taken using aLeica SP5 confocal microscope.

Crystallization and Structure Determination of HopQ^(AD) and of aComplex of HopQ^(AD) and C1ND

HopQ^(AD) was concentrated to 40 mg/mL and crystallized by sitting dropvapor diffusion at 20° C. using 0.12 M alcohols (0.02 M 1,6-Hexanediol;0.02 M 1-Butanol; 0.02 M 1,2-Propanediol; 0.02 M 2-Propanol; 0.02 M1,4-Butanediol; 0.02 M 1,3-Propanediol), 0.1 M Tris (base)/BICINE pH8.5, 20% v/v PEG 500* MME; 10% w/v PEG 20000 as a crystallizationbuffer. Crystals were loop-mounted and flash-cooled in liquid nitrogen.Data were collected at 100 K at beamline Proximal (SOLEIL,Gif-sur-Yvette, France) and were indexed, processed and scaled using theXDS package. All crystals were in the P2₁ space group with approximateunit cell dimensions of a=57.7 Å, b=57.7 Å, c=285.7 Å and beta=90.1° andfour copies of HopQ^(AD) per assymetric unit. Phases were obtained bymolecular replacement using the BabA structure, and the model wasrefined by iterative cycles of manual rebuilding and maximum likelihoodrefinement using Refmac5. Table 1 summarizes the crystal parameters,data processing and structure refinement statistics. To form a complexbetween HopQ^(AD) and the N-domain of human CEACAM1 (C1ND), purifiedrecombinant C1ND was added in a 1.2-fold molar excess relative topurified HopQ^(AD), and the mixture was injected onto an Hi-Prep™ 26/60Sephacryl S-100 HR column (GE Healthcare) pre-equilibrated in 20 mMTris-HCl pH 8.0, 500 mM NaCl buffer. Fractions containing theHopQ^(AD)-C1ND complex were pooled together and concentrated to a finalconcentration of 30 mg/mL using a 30 kDa MW cutoff spin concentrator.Crystals were obtained in 0.03 M sodium fluoride, 0.03 M sodium bromide,0.03 M sodium iodide, 0.1 M MES pH 6.5, 20% v/v Ethylene glycol and 10%w/v PEG 8000. Crystals were loop-mounted and flash-cooled in liquidnitrogen, and data were collected at 100 K at beamline Proxima 1(Soleil, Gif-sur-Yvette, France). Crystals were in the C2 space groupwith approximate unit cell dimensions of a=118.0 Å, b=174.0 Å, c=118.1Å, beta=118.4 and three copies of HopQ^(AD)-C1ND per assymetric unit.Phases were obtained by molecular replacement using the HopQ^(AD) andC1ND (PDB code 4WHD) structures, and the model was refined by iterativecycles of manual rebuilding and maximum likelihood refinement usingRefmac5. Table 2 summarizes the crystal parameters, data processing andstructure refinement statistics.

Amino Acid Sequence Alignment

The amino acid sequence alignment of the N-terminal domains of human,mouse and rat-CEACAM1 and human CEACAMs (1, 5, 6 and 8) was performedusing CLC main Workbench (CLC bio).

Luciferase Reporter Assays

CHO-CEACAM1-L cells transfected with various luciferase reporter andcontrol constructs (Clontech) were infected with H. pylori for 5 h andanalyzed by luciferase assay using the Dual-Luciferase Reporter AssaySystem according to the manufactures instruction (Promega, USA).Briefly, cells were harvested by passive lysis, the proteinconcentration was measured with Precision Red (Cytoskeleton, USA) andthe lysates were equalized by adding passive lysis buffer. Theluciferase activity was measured by using a Plate Luminometer (MITHRASLB940 from Berthold, Germany).

Animal Experiments

Specific pathogen free, 120-150 gr male Sprague dawley rats, 4 weeksold, were obtained from Charles River Laboratories, Sulzfeld, Germany.Animals were randomly distributed into the different experimental groupsby animal care takers not involved in the experiments, and criteria forthe exclusion of animals were pre-established. Investigator blinding wasperformed for all assessment of outcome and data, histology wasperformed by an independent investigator in a blinded manner. Animalswere challenged twice intragastrically in groups of 8 with ˜1×10⁹ liveH. pylori in 2 interval days. The experiments were performed in thespecific pathogen-free unit of Zentrum für Präklinische ForschungKlinikum r. d. Isar der TU München, according to the allowance andguidelines of the ethical committee and state veterinary office(Regierung von Oberbayern, 55.2-1.54-2532-160-12).

Statistical Analysis

For in vitro experiments, normal distribution was determined byShapiro-Wilk test. All data were analyzed with two-tailed Student t-testand one-way ANOVA with post hoc Bonferroni test (comparing more than twogroups) using Graph Pad Prism Software. Data are shown as means±s.e.m ors.d. for at least three independent experiments. P values<0.05 wereconsidered significant. For animal studies, power calculation wasperformed based on previous animal experiments to achieve two sidedsignificance of 0.05 while using lowest possible numbers to comply withthe ethical guidelines for experimental animals.

REFERENCES

-   -   1. Apostolopoulos, V. et al., 2013. Targeting antigens to        dendritic cell receptors for vaccine development. Journal of        Drug Delivery, 2013:869718.    -   2. Belogolova, E. et al., 2013. Helicobacter pylori outer        membrane protein HopQ identified as a novel T4SS-associated        virulence factor. Cell Microbiol. 15, pp. 1896-1912.    -   3. Blaser, M. J. et al., 1995. Infection with Helicobacter        pylori strains possessing cagA is associated with an increased        risk of developing adenocarcinoma of the stomach. Cancer        Research, 55(10), pp. 2111-2115.    -   4. Cao, P. & Cover, T. L., 2002. Two different families of hopQ        alleles in Helicobacter pylori. Journal of Clinical        Microbiology, 40, pp. 4504-4511.    -   5. Forman, D., 1996. Helicobacter pylori and gastric cancer.        Scandinavian Journal of Gastroenterology. Supplement, 214, pp.        31-3-discussion 40-3.    -   6. Fox, J. G., 2002. The non-Helicobacter pylori helicobacters:        their expanding role in gastrointestinal and systemic diseases.        Gut, 50, pp. 273-283.    -   7. Fox, J. G. et al., 1998. Hepatic Helicobacter species        identified in bile and gallbladder tissue from Chileans with        chronic cholecystitis. Gastroenterology, 114, pp. 755-763.    -   8. Gao, W. et al., 2010. The evolution of Helicobacter pylori        antibiotics resistance over 10 years in Beijing, China.        Helicobacter, 15(5), pp. 460-466.    -   9. Gómez-Gascón, L. et al., 2012. Exploring the pan-surfome of        Streptococcus suis: looking for common protein antigens. Journal        of Proteomics, 75(18), pp. 5654-5666.    -   10. Graham, D. Y. & Shiotani, A., 2005. The time to eradicate        gastric cancer is now. Gut, 54(6), pp. 735-738.    -   11. Hytonen, J. et al., 2006. Use of flow cytometry for the        adhesion analysis of Streptococcus pyogenes mutant strains to        epithelial cells: investigation of the possible role of surface        pullulanase and cysteine protease, and the transcriptional        regulator Rgg. BMC Microbiol., 6, 18,        doi:10.1186/1471-2180-6-18.    -   12. Jemal, A. et al., 2011. Global cancer statistics. CA: a        cancer journal for clinicians, 61(2), pp. 69-90.    -   13. Kalali, B. et al., 2014. H. pylori virulence factors:        influence on immune system and pathology. Mediators of        Inflammation, 2014:426309.    -   14. Koebnik, R. et al., 2000. Structure and function of        bacterial outer membrane proteins: barrels in a nutshell.        Molecular Microbiology, 37(2), pp. 239-253.    -   15. Matsukura, N. et al., 2002. Association between Helicobacter        bilis in bile and biliary tract malignancies: H. bilis in bile        from Japanese and Thai patients with benign and malignant        diseases in the biliary tract. Jpn J Cancer Res., 93(7), pp.        842-7.    -   16. Mori, J. et al., 2012. Chimeric flagellin as the        self-adjucanting antigen for the activation of immune response        against Helicobacter pylori. Vaccine, 30(40), pp. 5856-5863.    -   17. Nomura, A. et al., 1994. Helicobacter pylori infection and        the risk for duodenal and gastric ulceration. Annals of Internal        Medicine, 120(12), pp. 977-981.    -   18. Parsonnet, J. et al., 1991. Helicobacter pylori infection        and the risk of gastric carcinoma. New England Journal of        Medicine, 325(16), pp. 1127-1131.    -   19. Perez-Perez, G. I. et al., 2004. Epidemiology of        Helicobacter pylori infection. Helicobacter, 9 Suppl 1, pp. 1-6.    -   20. Pisani, P. et al., 2008. Cross-Reactivity between Immune        Responses to Helicobacter bilis and Helicobacter pylori in a        Population in Thailand at High Risk of Developing        Cholangiocarcinoma. Clin Vaccine Immunol., 15(9), pp. 1363-1368.    -   21. Shiota, S. et al., 2010. Population-based strategies for        Helicobacter pylori-associated disease management: a Japanese        perspective. Expert Review of Gastroenterology & Hepatology,        4(2), pp. 149-156.    -   22. Singer, B. B. et al., 2014. Soluble CEACAM8 interacts with        CEACAM1 inhibiting TLR2-triggered immune responses. PLoS One, 9,        e94106.    -   23. Sioud, M. et al., 2013. A novel peptide carrier for        efficient targeting of antigens and nucleic acids to dendritic        cells. FASEB J., 27(8), pp. 3272-3283.    -   24. Song, H. et al., 2015. A novel chimeric flagellum fused with        the multi-epitope vaccine CTB-UE prevents Helicobacter        pylori-induced gastric cancer in a BALB/c mouse model. Appl        Microbiol Biotechnol., 99(22), pp. 9495-9502.    -   25. Tchoupa, A. K. et al., 2014. Signaling by epithelial members        of the CEACAM family—mucosal docking sites for pathogenic        bacteria. Cell Commun Signal, 12:27.    -   26. United States Centers for Disease Control and Prevention        (2011). “A CDC framework for preventing infectious diseases”,        accessed 20 Dec. 2012.

The invention claimed is:
 1. A method of treating a disease or disordercaused by or associated with H. pylori, the method comprising the stepof administering an inhibitor of an interaction between Helicobacterpylori HopQ and a member of the carcinoembryonic antigen-related celladhesion molecule (CEACAM) family, wherein the inhibitor is selectedfrom the group consisting of (a) (poly-)peptide ligands binding to anextracellular domain of H. pylori HopQ; and (b) nucleic acid moleculesencoding the (poly-)peptide ligands of (a); wherein the extracellulardomain of H. pylori HopQ is the insertion domain, loop A, loop B, loop Cor loop D of H. pylori HopQ, wherein loop A is located between helix H3and strand S1 of H. pylori HopQ; loop B is located between strand S2 andhelix H4 of H. pylori HopQ; loop C is located between helix H5 and helixH6 of H. pylori HopQ; and loop D is located between helix H7 and helixH8 of H. pylori HopQ, wherein the inhibitor inhibits binding of H.pylori HopQ to an extracellular domain of the member of the CEACAMfamily, and/or wherein the inhibitor inhibits binding to the N-domain ofthe member of the CEACAM family.
 2. The method of claim 1, wherein theinhibitor inhibits binding of H. pylori HopQ to the member of the CEACAMfamily and/or HopQ-CEACAM-mediated signaling.
 3. The method of claim 1,wherein the member of the CEACAM family is selected from the groupconsisting of human CEACAM family members, non-human primate CEACAMfamily members and rat CEACAM family members.
 4. The method of claim 1,wherein the disease or disorder caused by or associated with H. pyloriis selected from the group consisting of H. pylori infection andgastroduodenal disorders caused by H. pylori.
 5. The method of claim 1,wherein the member of the CEACAM family is selected from the groupconsisting of CEACAM1, CEACAM3, CEACAM5 and CEACAM6.
 6. The method ofclaim 4, wherein the gastroduodenal disorders caused by H. pylori areselected from the group consisting of gastritis, chronic gastritis,gastric atrophy, gastric or duodenal ulcer, stomach cancer and MALTlymphoma.